New User Account Request Form


Please provide the following information:

First Name
Last Name
Middle Initial (required)
Date of Birth (mm/dd/yyyy)
Gender Male Female
Title
Division
Employee Classification Faculty
Staff   
Office
Cell Phone
Work Phone  
Printer Access  (Which network printer?)
SCT PowerCampus Access   Yes   No
  (also email jalinder@marianuniversity.edu for an account)
Shared Network Folder Access    (department shared folder)
   
Enter Your Name  

Revised: September 06, 2011