HTML Preview Account Application Form page number 1.
Social Science Research Institute
Computer Account Application Form
All information is required. Incomplete forms will not be processed.
This application is for: A new account Renewal or change of information
Full Name (Last, First, Middle Initial): _______________________________________________________________________
Department: ____________________________________________________________________________________________
Office Address: _________________________________________________________________________________________
Office Telephone: ______________________________ PSU Access Account ID: _____________________ @ psu.edu
User Category
: Graduate Student – Demography Faculty
(Select One Only) Graduate Student – Other: _________________________ Staff – Full Time
Work Study Staff – Part Time (wage payroll)
Other: _________________________________________
Why are you applying for an account? ______
__________________________________________________________________
_______
_________________________________________________________________________________________________
STUDENTS ONLY
Who is your advisor?_______________________________________________________________________________________
For which PRI faculty are you doing research (if any)?_____________________________________________________________
Are you using the account for a class (if yes, which class?)__________________________________________________________
Student accounts must be renewed annually or at the beginning of the fall semester.
Accounts not renewed by that date will be removed.
I agree to abide by the licensing agreements governing the use of all software on this system in addition to the policies of the
University and department regarding computer use. I understand that this account is for my use and my use only, and my password
must never be given to anyone for any reason, without written consent from the Director.
Applicant’s signature:______________________________________________ Date:________________________
Please return this form to the bin outside room 804 Oswald Tower. We will notify you via email when your account is ready.
DO NOT WRITE BELOW THIS LINE
Username:________________________ Group:___________________________ Date: _____________________________
Notes: _____________________________________________________________ Form executed by:___________________
June-2013