REQUEST FOR ECN ACCOUNT

For ECN Use
Date entered: ________________________
By: ________________________________

Date _______/_______/_______

Machine: ____________________________
Groups: _____________________________

PRINT clearly in block letters

Quota: ______________________________

Read completely, then sign.

___________________________________

Name: ________________________________________________________________________________________
First
Middle Initial
Last
Please print Purdue (Career Account) Login:_______________________________________@purdue.edu
Check ALL the following boxes that apply:

 Faculty
 Staff
 Graduate Student
 Undergraduate Student
 Non-Engineering Person
 Non-Purdue Person Working on a Purdue Project or at a Purdue Center
 Other

_______________________

Expected Graduation Date/Project Termination Date: ______________________________
Dept: _____________________ Bldg: ___________ Room: ___________________ Phone: _____________________

Major Professor/Supervisor/Purdue Contact: _____________________________________ Phone: _______________
Authorized by: ___________________________________________________________________________________
Name

Signature

By signing below, I agree to abide by all elements of the Purdue University Engineering Computer Network “Policy on Access
and Usage” listed at: https://engineering.purdue.edu/ECN/Resources/KnowledgeBase/Docs/20020202095905
I understand that upon violation of this policy, the Engineering Computer Network retains the right to deny access privileges, and
that if warranted; further disciplinary action may be taken by the University, including prosecution under applicable state and
federal laws.

___________________________________________________________________ __________________________
Signature
Date
Revised February 20, 2006