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ITSU

Request for Email user Account


Name: ___________________________________________ ID No.: ________________
School/Center/Unit: ________________________________ Tel No.: ________________
Requested Login Name: _____________________________Password: _______________
Description of account (if different from the name above) __________________________
Period Requested From: ________________________To___________________________
(dd/mm/yy)
(dd/mm/yy)
Account Email: 1 Faculty
Classification
Use

1 Staff
Use

1 Student
Use

1 Office
Use

Requestors signature: _________________________________Date: _________________

For Office Use Email Account Only


Approved by Dean/Unit Head: _______________________________________________
Name: __________________________________ Signature : ______________________
Date: _________________________________________________________

For ITSU only


Approved by:
Name: ____________________Signature: : __________________ Date: __________
Job completed by:
Name: ____________________Signature: : __________________ Date: __________
Doc.No: ______________

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