Please fill in the fields below. Use the "Print" button on your web brower to print this form then hit the "submit" button below. Have the sponsor and applicant sign the hardcopy where indicated. Put the resulting form in the mailbox of Brad Hill or Jason Simpson in the Bren Mail Room, or mail to: Bren Computing, 3408 Bren Hall, UCSB, Santa Barbara, CA 93106-3060. Note: Incomplete forms will NOT be processed. Account creation may take up to 72 hours to complete. Bren Computing will supply the applicant with a password in-person or via telephone.
Each account is for a single individual. Sharing of an account is grounds for account revocation. Passwords should never under any circumstance be sent via email.
Request Date: 11/21/2008 10:34:37 AM
Applicant Name: Last First Middle
Current email address:
Applicant Title: Faculty Staff Master's Student Non Bren Student PhD Researcher Visitor Name of Sponsor
Local Address: street state zip phone
Permanent Address: street state zip phone
Campus Address (if any) Campus Extension (if any)
RESOURCES NEEDED
Check any of the following that are needed:
Is a Corporate Time calendaring account needed? Yes No
Signature of Sponsor X _________________________
Using this account implies consent to abide by The University of California Electronic Communications Policy . You will be redirected here when you click the "Submit" button below.
Applicant Signature X _____________________________
Please tell us a little about your computing needs and where you will be housed:
