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. After submitting this request, you will be asked to enter your Ohlone College email account username and password.

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

* = Required

Employee Information

* Colleague ID Number:
* First Name:
* Last Name:
* Department:
Room Number:
* Job Title:
* Employee Start Date:	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Employee Status (select one)

Full-Time Faculty	Part-Time Faculty
Classified	Contract
Manager	Other Hourly
Administrator

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

Computer:	No Mac PC Other	Computer Barcode:
Telephone:	Yes No	Office Phone Extension:
	If a telephone is needed, what type?: Single-Line Multi-Line None
	Employee's Alternate Phone Number: () - extension

Supervisor Information

* First Name:
* Last Name:
* Phone Extension:

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.