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Information Services

Technology. Communications. Solutions

Network Connection Request Form

All fields that are required must be filled in. Your request will not be processed unless they are filled in. Please see the Explanation of Terms page for help with filling out the fields.

If you have any problems with this form please contact the Operations Center at 472-5653.

User Information

This must be filled in with the contact information for the person who is actually using the computer being registered.

Name of the Primary User: (Required)
Department if Faculty/Staff or Resident Hall
if Student: (Required)
User's Telephone Number: (Required)
User's E-mail Address: (Required)
Preferred Machine Name:

Technical Contact Information

This must be filled in with the contact information for your department's technical contact.
Contact's Name: (Required)
Contact's Telephone Number: (Required)
Contact's E-mail Address: (Required)

System Location

Please make sure you have entered the BUILDING name and not a center or department.
Building the System is Located In: (Required)
Room Number: (Required)

System Information

Network Card Number/Address: (Required)

This number must be 12 digits. Use only hexadecimal characters (0-9, a-f)—do NOT use any dashes “-” or colons “:” in the number.
Is This A Replacement Card?
If it is a Replacement please enter the old Card Number, IP Address, or registered Hostname:
Operating System: (Required)

Use the Notes field below to explain anything unusual about your request. You may also use it to specify additional IP requests, just enter the additional ethernet numbers and any other pertinent information below.

Notes:

Wireless Network Connection Registration

Other Network Connection Requests (i.e., Departmental Port Activation or Access in a UNL Residence Hall)