Network Access Request Form

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

* indicates required field

Name:*

Email:*

CS Mail addresses only

Advisor's Name:*

Room Number:*

Room Number where the machine will be located

Do You need a network port activated in the room?*

Yes
No

Port Label:

The label on the port. example: 2F31

Type of Network:*

DHCP (Laptops, Notebooks)
Static (Desktops, Servers)

MAC Address of Requested Interface

MAC (Hardware) address of requested interface
Such as: 08:00:20:a3:23:9e
This is required for DHCP

Requested Machine Name:

Required only for static addresses. Please enter a fully qualified domain name. (.cs.ucla.edu)
example: yourpc.cs.ucla.edu

Machine Type:

Sun, Windows, Linux, Mac OS, etc.

OS Version:

Comments:

UCLA has mandated the installation of Trellix endpoint agent. I agree to install and run the agent on my machine.*

I agree to abide by IT policies set forward by UCLA and UCOP.*

(please wait for a response after clicking Submit)