Physics Department Computer Account Form

Please return this form to the Physics Office front desk or Brad Hawks (308 JFB)

Date: ___/___/___ Processed [ ]

User Information

First Name:____________________ Last Name:____________________

Phone Number:____________________

UU ID# _ _ _ _ _ _ _ _

UCard# 9840 - 0000 - _ _ _ _ - _ _ _ _ (Underneath your name on your UCard)

[ ] Physics Student and/or Physics Department Faculty or Staff

[ ] New Account

[ ] Account Renewal

Desired Username/ Current Username:____________________

User Signature:________________________________

(your email address will be <username>@physics.utah.edu)

Regular Account Types

[ ] Undergraduate Student

[ ] Non-Research/Teaching Assistant/New Graduate Student

[ ] Staff

[ ] Faculty

Authorizing Signature:______________________________

(Authorization may be from any office staff, supervisor, or instructor)

Research/ Special Account Types

[ ] Undergraduate Research Assistant

[ ] Graduate Research Assistant

[ ] Post Doctorate

[ ] Visiting Faculty or Special Account

Principal Investigator or Sponsor's Name (printed):____________________

Authorizing Signature:______________________________

(Must be PI or Sponsoring Faculty)