Network Jack Activation Request (Form JA)

This form is to request activation of a campus network jack. Please provide the information requested below to make your computer installation as trouble-free as possible.

* indicates a mandatory field

User Information
Name*:	Department:
Email address*:	Phone*:
New Jack Information
Building*:	Jack #*
Room*:	Desired completion Date:
Device Information (about the device to be connected to the jack)
Type of Device*: Computer Printer Other	If Other, specify:
Please check if either of the items below apply:
Computer is a Macintosh	Computer is for a computer lab or for student academic usage
Previous Network Jack
May we deactivate another jack so you are not charged for both? Yes
If yes, which jack?	Room:
Building:	Jack:
Budget Information
The current price for a network jack is $185 for activation. There is a $3.50 per month maintenance fee.
Budget Authority (person's name)*:	Account number to charge*:
Comments:
If this request is in support of another ITS HelpDesk issue, please enter the issue number: Check if this is a high-priority request: High Priority For security, please enter in the number in this image*:

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