New User Account Request Form - Information Technology Department

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

If you need assistance filling out this form, please call (510) 659-7333.

* indicates a Required Field.

Employee Information

* Employee Start Date

Employee Status (select one)

Full-Time Faculty
Classified
Manager
Administrator

Part-Time Faculty
Contract
Other Hourly

Is the Employee's Office/Desk Equipped With…?

* Computer

No computer
Mac
PC
Other

Computer Barcode

* Telephone

Yes
No

Office Phone Extension

If a telephone is needed, what type? Single-Line
Multi-Line
No Phone Needed

Employee's Alternate Phone Number
( ) - extension

Supervisor Information

Special Instructions

Please include any additional information for account setup or access privileges:

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

If you need assistance filling out this form, please call (510) 659-7333.

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