UNIVERSITY OF PITTSBURGH \ FORM INSTRUCTION GUIDE



FORM TITLE:         NETWORK ADDRESS REQUEST
NUMBER:             FORM 0024
PROCEDURE:          10-02-13



*  Shaded areas to be completed by CIS

_

ENTER THE FOLLOWING INFORMATION, WHERE INDICATED:

    1.    Requestor's Name (Last, First, Middle Initial  -  Limit
          to 39 characters)

    2.    University  Personal Reference (PR) Number (PNNNNNNNNN)
          from the reverse side of the University ID Card

    3.    Campus Address (For building abbreviations refer to SPI
          9)

    4.    Campus  Telephone  Number,  including  area  code  (3),
          telephone  number (7), and extension (4) if  applicable
          (AAA-NNN-NNNN-XXXX)

    5.    Electronic  Mail Address (EMail), your VAX/VMS  Cluster
          Username

    6.    School/Responsibility Center

    7.    Department

    8.    Signature of Requestor

    9.    Date of Signature

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NETWORK DEVICE INFORMATION


   10.    Device Location (Room and Building)

   11.    Device Type (e.g., PC, Terminal)

   12.    Device Operating System, if applicable (e.g., DOS 3.3)

   13.    Device Ethernet Address, if applicable (e.g., xx-xx-xx-
          xx-xx-xx)


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CIS ASSIGNED DEVICE ADDRESS INFORMATION (If Applicable)

   14.    Device Domain Name (e.g., VMI.RIDC.NAS.COM)

   15.    Protocol (e.g., TCP/IP)

   16.    Protocol Node Name (e.g., CISVMS)

   17.    Protocol Address (A number assigned by CIS)

   18.    Date completed