Information Technology - UCA

Student Worker/Graduate Assistant Access

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

How to use this form:

Read the instructions before using this form.
This form is used to request service access to graduate assistants and/or student workers.
The information on this form is necessary in order for us to be able to grant the access. Fill in the form and click the "Send Request" button at the bottom.
The access granted by this request will remain available to the student until the department removes it or request that it be removed by IT.

Student Information
Student Name:
UCA ID Number:
UCA Email Address:
Department Information
Department Name:
Office Phone Number:	- -
Building Name:
Room Number:
Department Head Name:
Department Head Email Address:
Request Access
Access to Department Mailbox:	Yes No Please specify a mailbox:
Access to Pool Directory:	Yes No View Information About Pool Drives Please specify a pool directory:
Contact Information
Contact Name:
	(person to notify regarding request)
Contact Email Address:

Additional Information
Comments: