Network Access Request Form

Before you request an IP address, please do an 'nslookup' to make sure that the name that you are requesting is available.

* = Required

First Name:
 *
Last Name:
 *
E-mail:
(CS email addresses only)
 *
Verify E-mail:
 *
Advisor's Name:
 *
Room number where the machine will be located:
 *
Do you need a network port activated in the room?
Yes No
Type of Network:
 DHCP Static *
MAC (hardware) Address of requested interface:
(Example: 8:0:20:a3:23:9e)
 Required for DHCP
Requested Machine name:
 (Static addresses only)
Machine Type:
(Sun, Windows, Linux, Mac OS, etc.)
 *
OS Version:
   
Comments:

(Please wait for a response after clicking Submit.)