Shared E-mail Account Request Form

Please complete and print the following form for each shared e-mail account you wish to have created. The completed form, along with the appropriate chair, supervisor or advisor signature must then be sent to User Support Services, who will forward the request to the system administrators for approval.

IITS will conduct routine checks every semester to verify that this account is actively being used. Inactive accounts may be removed from the system.

Please complete all fields below:

SHARED E-MAIL ACCOUNT INFORMATION
Desired e-mail address:	@longwood.edu
Purpose for the account:
Date to Delete:	* If permanent, leave blank.

REQUESTED ACCESS
LancerNet ID	Access [Help]

POINT OF CONTACT INFORMATION
Name:
Department or Organization:
Phone Number:
Point of Contact E-mail Address:	@longwood.edu

CHAIR, SUPERVISOR, OR ADVISOR APPROVAL
By signing, you authorize creation of the above named shared e-mail account on Longwood's e-mail servers. You verify that the account will be used in accordance with Longwood's Acceptable Use Policy and that any abuse of the account will be immediately reported to IITS.

Name (printed):		Signature:	____________________________________
Date:

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For IITS Use Only!

Sys. Admin. Signature: ____________________________________________

Date: ___________________________