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Kansas State University

                                             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!):

                                             

        First Name :      

           

        Middle Name :   

        Last Name :     

          

        If Student choose - Class OF :     

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

       Department / Unit:(Select one):    

       Where is your Office Located?: (Select one):    

        What is your Office Room Number?:   

       Work Phone Number :         

        Birthday(MM/DD/YYYY):

       VetView Account Information:       

               Lab Name:   
               I need the same access as this Current VetView 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.

Signature: Date: