UPPS No. 04.01.02 Vax Account Request Form
Attachment I
VAX ACCOUNT REQUEST FORM
Southwest Texas State University
Computing Services Department
Type or print the answers to the following and send ALL copies to Computing
Services, JCK 720. Call 2501 if you have any questions.
_____________________________________________________________________________
INDIVIDUAL REQUESTS
Please check one:
____ Faculty ____ Staff ____ Student Employee ____ All-In-One
Full Name SSN Department Username
1. ___________________ ________________ __________________ ________________
2. ___________________ ________________ __________________ ________________
3. ___________________ ________________ __________________ ________________
4. ___________________ ________________ __________________ ________________
5. ___________________ ________________ __________________ ________________
DELETIONS: List Usernames below.
_______________ ________________ _________________ _________________
__________________ __________________________ _______________ ____________
Dept. Account No. Account Manager's Sign. Phone No. Date
_____________________________________________________________________________
CLASS ACCOUNT REQUESTS
Course Prefix Course Number Course Suffix Course Section No.
1.________________ _______________ __________________ __________________
2.________________ _______________ __________________ __________________
3.________________ _______________ __________________ __________________
4.________________ _______________ __________________ __________________
5.________________ _______________ __________________ __________________
______________ ______________________________ ______________ ____________
Dept. Acct. No. Account Manager's Signature Phone No. Date
_____________________________________________________________________________
Computing Services Use ONLY
Approved by: ___________________________ Date: ______________________