New User Account Request Form - Information Technology Services (ITS) Department

This form is intended to be used by an employee's supervisor to initiate services from the Information Technology Services Department.

If you need assistance filling out this form, please call the ITS Service Desk at (510) 659-7333.

Asterisk (*) indicates a required field.

Contact Information for person making this request
Employee Information for New User Account

Campus:

* Employee Status (select one)
Is the Employee's Office/Desk Equipped With…?
* Computer
  • - if Other, please describe:
* Telephone
  • (include Office Telephone Number below)

The Employee Account Needs (select one or more):
Special Instructions

(Special Instructions are required for Colleague account setup and security.)

If you need assistance filling out this form, please call the ITS Service Desk at (510) 659-7333.

Your privacy is important to us. Your personal information will not be sold or shared with unaffiliated third parties except as necessary to maintain and process client accounts or when the law requires it.