Rhode Island College User Support Services
Faculty/Staff Network Account Application Form

Please complete this form to request a new network/email account.  This form must be signed by your departmental chair or director.

Date of Application

Department            Building                    Room#                         Campus Phone Ext #

Empl ID # / Peoplesoft

First Name                                  M                        Last Name

Contact Phone #                           

Current Position at Rhode Island College: (pick one)

Full-time Faculty/Staff      Adjunct Faculty      Part-time Staff  
Other - Please specify 

How do you wish to obtain your username and password?
  E-mail (Please provide e-mail address) 
  Campus mail
  Hold for pick up at HMTC

Agreement to abide by the Policy for Responsible Computing

I have read the Rhode Island College Policy for Responsible Computing (http://stg-www.ric.edu/uss/policies.php) and agree to comply with the guidelines set by the policy

                                      Signature                                                         Date

Authorization from you Department Chair or Director

Full Name:                                                                               Title:                               

Department:                                                                             Dept. Ext: