Request for New Generic Exchange Account for Student Access

(This account can be used by one or more students)

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

Note: Managers and students must have a Windows Network Account. Managers must be employees of the University in the department specified below. Aliases will be representative of account purpose. (e.g. registrar01@uamail.albany.edu)

Department:

Purpose of Account:

Global Address List Display Name:

Manager/Owner Information

(Manager will have access to this account.)

Last Name:	First Name:
NetID:

Student(s) to be Granted Access:

Last Name

First Name

NetID

ITS CSS Contact Signature:

ITS CSS Contact Printed Name:

ITS CSS Contact Phone:

Date:

Fax To:  CSS Accounts and Access Office, 442-3847