HTML Preview Account Application Form Sample page number 1.
Computer Account Application
Computing and Telecommunications Services
Please read and fill out this application completely. Applications that are not complete or for persons not already processed in
Human Resources, School of Medicine, or the Registrar will not be processed. If you have questions about this application,
contact the Help Desk. Please return completed application to the Help Desk in 025 Library Annex or fax to (937)775-3331.
*Required Fields
Last Name* First Name* Middle Name*
Department* University ID #*
Legal Responsibilities:
The purpose of this statement is to inform you of your legal responsibilities and requirement as a user of Wright State University computer systems.
Your account is to be used only for authorized use. All users must be registered with Computing and Telecommunications Services. Frivolous applications,
commercial use, and unauthorized use or misuse (game playing, unauthorized use of files, any form of personal harassment, etc.) are prohibited and could
result in the loss of your account and charges being brought against you through an appropriate University office. Your account(s) is (are) for your use only;
sharing of accounts and passwords is strictly prohibited. For acceptable use guidelines for campus computing, see:
http://www.wright.edu/wrightway/3002.html
Students must be authorized to register for classes to obtain and maintain an account. Access will be disabled during unauthorized quarters.
Password resets will be done only in person, with a government issued identification card (example: driver’s license). If this is not possible, please contact the
CaTS Help Desk.
I have read, understand, and accept the above responsibilities as an account holder, and I agree to comply with these and all WSU Computing and
Telecommunications Services policies and conditions.
Applicant’s Signature: *__________________________________________ Date: ___________________________
WSU Association* (check one)
Faculty (if Emeritus attach verification)
Classified/Unclassified Staff
Student
SOM Affiliate/SOM Resident
Other (Please Explain):
If authorization required, list Begin and End dates: Begin:_____
_
___
_
_________ End:____________________________
Authorizing Signature (print name and sign): ______________________________________________ Date:___________
Department Contact and Title Phone Number For Contact Person
**If this person is a NEW faculty, staff, contract employee or similar and has not been
processed by Human Resources, Registration, or the School of Medicine, then the
following MUST be filled in for Human Resource/Banner purposes.**
Ethnicity Soc. Sec. Number Gender
Date of Birth
Campus Location Dept. Org #
Reason for Request
U.S. Citizen? y/n
Applicant’s Phone Number FAX Number
Training Required:
Red Flags
PCI DSS