NOTE: Printing and/or faxing this form is not required.

How to use this form:

1. Read the instructions before using this form.
2. This form is used to request the physical connection of a device to the campus network. If you would like to obtain a network account for an individual then you want the Request A New Faculty and Staff Network Account Form.
3. Fill in the information in the text boxes below then click on the "Submit Request button at the bottom of the form.
4. There must be a device (usually a computer or printer) physically present at the location of the new connection before the connection will be made.
5. There must be an available data port in the room before the connection will be made. If you do not have a data port at this location and would like to have one installed, contact the UCA Information Technology Department at 450-3107.
6. Review the Minimum System Requirements and Device Restrictions for a network connection.
7. Incomplete forms will not be processed

This form is not necessary when you are just replacing a computer where there is already an existing connection.

Name of Person Requesting Connection
Department Name:	Academic Advising CenterAcademic OutreachAcademic Planning and AssessmentAccounting (Academic)Accounts PayableAdcock International HouseAdmissionsAffirmative ActionAlumni ServicesAramark Food ServicesArchivesArkansas Model UNArtAssessment OfficeAthleticsAudio Visual ServicesBaum Art GalleryBearCard CenterBiologyBookstoreBudgetBusiness Office (Financial Services)Business and Marketing EducationCalendar OfficeCareer Services CenterCashieringCenter for Academic SuccessCentral DuplicatingChannel 6ChemistryChild Study CenterCollege ViewCollege of Business AdministrationCollege of Education, Dean's OfficeCollege of Fine Arts and CommunicationsCollege of Health and Applied ScienceCollege of Liberal ArtsCollege of Natural Science and MathematicsCommunicationsCommunity School of MusicComputer ScienceConfucius InstituteControllerCooperative EducationCounseling ServicesDean of StudentsDevelopmentDisability Support ServicesEarly Childhood and Special EducationEchoEconomics and FinanceEducation Research, Assessment, and EvaluationEducational Media and Library ScienceEducational Renewal ZoneEnglishEnrollment ManagementEnvironmental Health and SafetyFamily and Consumer SciencesFarris CenterFinancial AidFinancial and Administrative ServicesFitness CenterGeographyGovernmental RelationsGraduate StudiesGreek ServicesHPER Fitness CenterHealth Promotion and WellnessHealth SciencesHistoryHonors CollegeHousing and Residence LifeHughes Residential CollegeHuman ResourcesIndependent StudiesInformation TechnologyInstitutional AdvancementInstitutional ResearchInstructional Develop CenterIntensive English ProgramInternal AuditInternational AffairsIntramural Sports and RecreationInventory ControlKCON and KUCA RadioKinesiology and Physical EducationLeadership StudiesManagement Information SystemsMarketing and ManagementMass Communications and TheatreMathematics Military ScienceMinority ServicesMultimedia Resource CenterMusicNursing Occupational TherapyOrientation and Leadership DevelopmentOxford AmericanOzark HeritagePayrollPerkins LoansPhilosophy and ReligionPhysical PlantPhysical TherapyPhysics and AstronomyPolitical SciencePost OfficePresident's OfficePrint ShopProfessional Field ServicesProvost's OfficePsychology and CounselingPublic AppearancesPublications and Creative ServicesPurchasingRegistrarReynolds Box OfficeScrollSmall Business Advancement National CenterSociologySpeech and Language PathologySpeech and Public RelationsSponsored ProgramsSports InformationState Residential CollegeStudent AccountsStudent ActivitiesStudent CenterStudent Financial AidStudent GovernmentStudent Health ServicesStudent Information DeskStudent LifeStudent ServicesStudent TeachingSupply StoreroomTeaching and Learning TechnologyTechnology Learning CenterTesting OfficeTitle III GrantsTorreyson LibraryTravelUCA STEM InstituteUndergraduate StudiesUniversity CollegeUniversity PoliceUniversity RelationsUniversity TrainingUpward BoundVeterans CertificationWeb DevelopmentWorld Languages, Literature and CulturesWriting
Office Phone Number:	- -
Building Name:	Adcock International HouseArkansas HallAthletic AdministrationBaldridge ApartmentsBaridon HallBaum GalleryBear HallBear Village ApartmentsBernard HallBrewer Hegeman Conference CenterBruce Street ApartmentsBuffalo Alumni HallBuilding SouthBurdick HallCarmichael HallChild StudyChristian CafeteriaCollege SquareCollege of Business BuildingConway HallDenney HallDoyne Health Science CenterElizabeth Place ApartmentsErbach ApartmentsEstes StadiumFarris CenterFarris HallFerguson ChapelHarrin HallHealth, Physical Education, Recreation CenterHousing Maintenance WarehouseHughes HallInternal Audit HouseIrby HallLaney HallLewis Science CenterMashburn HallMath, Computer Science, and TechnologyMcAlister HallMcCastlain HallMeadors HallNew HallOak Tree ApartmentsOld Main BuildingPhysical PlantPhysical Therapy CenterPolice DepartmentPresident’s HomePrince CenterReynolds Performance HallSchichtl Performing and Visual ArtsShort HallSnow Fine Arts CenterSpeech, Language, Hearing CenterStadium Park ApartmentsStanley Russ HallState HallStudent CenterStudent Health Services BuildingThompson HallTorreyson LibraryTorreyson Place ApartmentsTorreyson WestWingo Hall
Room Number:
Reason for New Connection:
Is wall jack present?	Yes No N/A
Department Head or Supervisor:
Contact Name/Telephone Number and Additional Comments