Information Technology Services

Departmental ~ Web Account Request

Please complete the form and give to your ITS CSS Contact for approval and submission.

Account Information

Requested NetID:

The NetID must be 3-8 characters in length and represent the Department or project.

Initial Password:

(You must follow the password rules.)

Purpose of Account:

Display Name:


Department Budget#:

(for tracking purposes only)

Account Expiration Date:

Owner Information

Last Name:
First Name:

CSS Contact Signature:

CSS Contact Printed Name:


CSS Contact Phone:





Fax To:  Identity and Access Management Group (IAMG), 442-3847
College of Arts and Sciences faculty and staff, fax form to 442-3882


University at Albany