Computer Resource Request Form

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Last Name:

First Name:

Middle Initial:

SE ID #:

Job Title:

Department:

Extension:

Building/Room #:

Supervisor Name:

Supervisor Email:

Check all that apply:

DPS   SE Computer Login
CampusConnect Faculty   CampusConnect Academic Records
CampusConnect Advisor   Other

*Expiration Date

Required for temporary or student employees on DPS.
Expiration is set to automatically expire the Monday following commencement on SE Computer Logins