Account Request Form

This form is for requesting an account for Central E-mail (axe)

Central WWW Server (sorrel) or Central Instructional (redwood)

..Central E-mail Server (axe) ..Central Web Server (sorrel)

..Instructional Computer (redwood)

..(EM) Emeritus Faculty ..(EX) Extended Education Faculty ..(GF) Guest Faculty

..(AF) Adjunct Faculty ..(VF) Volunteer Faculty ..(RA) Research Assistant (Staff)

..(OR) Club/Organization ..(SS) State Staff ..(FS) Foundation Staff

..(VS) Volunteer Staff ..(GS) Guest Student ..(GR) Grad-Student Not Enrolled

..(UB) Veterans Upward Bound

Requested Login Name (3-8 char):

If you selected OR enter your Club or Organization Name

Enter Responsible Party for your Club or Organization

Your email address:

Enter Full Name (first, mi ,last)

Enter your Social Security Number

Enter your date of birth

Enter your Contact Address

Enter your Contact Phone Number