Please complete and print the following form for each website you wish to create. The completed form, along with the appropriate advisor signature must then be sent to User Support Services, who will forward the request to the system administrators for approval.

Please complete all fields below:

WEBSITE INFORMATION

URL:

Is this a: New Site Change to an Exisiting Site

POINT OF CONTACT INFORMATION

Name:

Organization Name:

Phone Number:

LancerNet ID:

E-mail Address:

ADVISOR APPROVAL

By signing, you authorize creation of the above named website on Longwood's server. You verify that the website will be used in accordance with Longwood's Acceptable Use Policy and that any abuse of the folder will be immediately reported to IITS.

Name (printed):

E-mail Address:
@longwood.edu

Signature: _______________________________________ Date: _______________

For IITS Use Only

Sys. Admin. Signature: __________________________________ Date: ____________