Data Jack Add/Change Request Form

Please fill out this entire form. Press the submit button when you are finished.

The request will automatically be submitted to the Director of Network Services
 

If you are moving your computer and need your data cable moved to another location.
If you are plugging your computer into a data jack that is currently empty.
If you are removing a computer from a data jack and the jack will be empty, we need to know.

Any data jack add or change needs to be requested via this form.

Please fill in the form below as completely as you can. If you are having trouble filling out the form, please contact the helpdesk at 5800.

Adds / changes received by Wednesday at 5pm will be reviewed and cataloged to go in Friday's program change. Any change not received by Wednesday at 5pm will not be processed until the following Friday.

* Designates Required Information

* Name of Person requesting change: 

* Request (check all that apply):
New Jack Activation 
Deactivate an unused jack
I need my computer moved in addition to the jack request.

Please provide the following information:

Jack number to Activate:   Room Number:
Jack number to Deactivate: Room Number:

* Is this jack for a: 

If this jack is for a specific person's use, what is their name?

What is the phone number of the person we would need to contact if we have questions about this request?
* Phone: 

SPECIAL NOTES OR COMMENTS:
*If you are using a small hub or switch you must tell us.
*Please give us any additional information you think we may need in the comment box below.
 

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