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.

First Name (Required)

Last Name (Required)

E-mail (Required)

CS email addresses only

Verify E-mail (Required)

Enter your email address again for verification

Advisor's Name (Required)

Room Number (Required)

Room number where the machine will be located

Do you need a network port activated in the room?

Yes
No

Type of Network (Required)

DHCP
Static

MAC Address of Requested Interface

MAC (hardware) address of requested interface, such as 8:0:20:a3:23:9e. This is required for DHCP

Requested Machine Name

Required only for static addresses. Please enter a fully qualified domain name such as example.cs.ucla.edu

Machine Type (Required)

Sun, Windows, Linux, Mac OS, etc.

OS Version

Comments

(Please wait for a response after clicking Submit.)