REQUEST FOR KSUCVM NETWORK ACCOUNT

            Please fill out the following information and submit.
            If you have any questions, please contact:

                            Steve Waldron                                                     DeAnna Jacklovich 
                            Network Administrator                 OR                 Network Administrator
                            406 Trotter Hall                                                   406 Trotter Hall 

            Please allow 24 hours for creation of new accounts. You will receive notification via 
            campus mail when the account has been created and made active, along with helpful 
            information about using the network. 

                                                     
                           INFORMATION IS USED TO CREATE USERNAMES & PASSWORDS

     If any information is filled out incorrectly on this form your account will not be created.
     Please see your department HR representative for your new account information.

        Status?: (Select one- please check with your HR representative if you are not sure!):

                                            Veterinary Student Veterinary Student and Student Worker Student Worker Graduate Student Classified Staff Unclassified Staff Faculty Other  

        First Name :      

        Middle Name :   

        Last Name :     

        If Student choose - Class OF :      None 2012 2013 2014 2015 2016 2017

        K-State eID: @ksu.edu     
      
       Position Title:     

       Department / Unit:(Select one):   A&P Alumni CaTs CMG CE Clinical Sciences VDL Deans Office Developement DMP Facilities Library Deans Business Office VHC Other  

       Where is your Office Located?: (Select one):   Coles Hall Mosier Hall MWV Research Park Trotter Hall Other  

        What is your Office Room Number?:   

       Work Phone Number :         

        Birthday(MM/DD/YYYY): 01 02 03 04 05 06 07 08 09 10 11 12 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

       Uvis Account Information:        I Do Not need a Uvis account (skip to Name of Supervisor)
I Do need a Uvis account (fill out this section)

               Lab Name:   
               I need the same access as this Current Uvis User:   
        (Please ask your supervisor if you are unsure)

        Name OF Supervisor:   

    The application for new accounts requires that the user agree and abide by all policies 
    of the KSU College of Veterinary Medicine and those of Kansas State University.   
    You can find the network policies for Kansas State University here: 
    http://www.k-state.edu/its/policies/ 

    You can find the College of Veterinary Medicine policies here: 
    http://www.vet.ksu.edu/depts/cats/manuals/handbook.pdf

    By typing in your First and Last Name below and clicking submit you agree that you have 
    read through all of these policies and understand and agree to abide by all network and
    e-mail use policies set forth by Kansas State University and the KSU College of Veterinary
    Medicine. You also agree to the responsibility for all transactions associated with your 
        network and e-mail accounts.