Kansas State University

                                             FIRST-YEAR STUDENT REQUEST FOR KSUCVM NETWORK ACCOUNT

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

                            DeAnna Jacklovich or Eric Herrman
                            Network Administrator
                            406 Trotter Hall
                                                                                                    

            Please allow 24 hours for creation of new accounts. You  will receive your password
            information with your new tablet, along with helpful information about using the network
            during orientation in August. 

                                                     
                           INFORMATION IS USED TO CREATE USERNAMES & PASSWORDS

     If any information is filled out incorrectly on this form your account will not be created.

        Status?: (Veterinary Student only selection available.):

                                            Veterinary Student  

        First Name :    

        Middle Name :

        Last Name :     

        Class Of:      2024

        K-State eID: @k-state.edu

        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 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 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

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.k-state.edu/education/handbook

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: