New User Account Request Form - Information Technology (IT) 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 the IT Helpdesk at (510) 659-7333.

Asterisk (*) indicates a required field.

Employee Information
Employee Status (select one)
Is the Employee's Office/Desk Equipped With…?
* Computer
  • (include Computer Barcode)
  • (include Computer Barcode)
  • - please describe:
* Telephone
  • (include Office Telephone Number)
If a telephone is needed, what type?
Supervisor Information
Special Instructions

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

If you need assistance filling out this form, please call the IT Helpdesk 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.