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 assignment of an IP Address.
3. Fill in the form and click the “Submit Request “ button at the bottom.

Note: If you install a static IP address on a workstation, you will have to add settings to your computer in order to be able to login to the network. Follow these steps:

1. Right-click on the red "N" in the lower right part of your screen and choose "Novell Client Properties".
2. Click on the "Service Location" tab
3. Enter "UCA" in the "Scope List" text box and click the "Add" button.
4. Enter "161.31.24.19" in the "Directory Agent List" text box and click its "Add" button.
5. Enter "161.31.24.18 in the "Directory Agent List" text box and click its "Add" button.
6. Click "Ok".

Contact Information:
Name:
Email Address:
Telephone Number:	- -
Department:	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
Device Information:
Name of Device Using IP Address:
Current IP Address Of Device:
	(if already connected to network)
Exact Location of Device:	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:
Purpose:
Notes/Comments
Comments: