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: ______________________