UNIVERSITY OF PITTSBURGH \ FORM INSTRUCTION GUIDE



FORM TITLE:         STUDENT SPECIAL PRIVILEGE APPLICATION
NUMBER:             FORM 0031 PITT 1355
PROCEDURE:          10-02-11



     INSERT THE FOLLOWING INFORMATION WHERE INDICATED:

    1.    Requestor's name (Last, first, middle initial- Limit to
          39 characters)

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

    3.    Campus   Address   (Refer  to  SPI   9   for   building
          abbreviations)

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

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

    6.    School/Responsibility Center

    7.    Department

    8.    Mark appropriate box: Undergraduate or graduate

    9.    Purpose of request:  Departmental or Research

   10.    CAP logname

   11.    Signature of requestor

   12.    Date of request

   13.    Enter appropriate information for VMS column

   14.    Enter appropriate information for UNX column

   15.    Enter expiration date(s)

   16.    Other requests

   17.    Reason for request


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COMPUTER ACCOUNTS SECTION

   18.    Approval signature

   19.    Disk structure

   20.    Date sent to RIDC Park

   21.    Expired Files structure

   22.    Signature of person confirming

   23.    Date of confirmation