Information Technology Special Request Form

Information Technology Special Request Form

Contact Information

Please complete the contact information section. We will contact your dean/manager for authorization. If approved, we will proceed to fulfill your request.

Your Name*

Please enter your first and last name.

L Number*

Please enter your Lane L Number

Your Email Address*

Please be sure to enter your full email address here.

Position*

Select

Your Contact Phone*

Building*

Please enter the building number where your office is located.

Room*

Please enter the room number of your campus office.

Dean/Manager Name*

Dean/Manager Email*

Please be sure to enter the full email address here.

Dean/Manager Contact Phone*

Equipment and Pickup/Delivery Request

Please select the equipment you are requesting and your requested date to receive the equipment.

What Equipment are you Requesting?*

NOTE: If you are requesting a laptop, you can pick it up when completed in Building 2, Room 123. Please see a help desk technician at the time of pickup. If you are requesting a desktop, you will receive an email to schedule delivery of your new equipment once it is ready.

N/A

Other hardware

Example: An additional monitor. With a supplied FOAP to cover additional hardware charges.

Additional Notes

Requested pickup or delivery date*

Please allow a minimum of 5 days from the date of this request to allow time for equipment preparation. We will contact you to finalize the pickup or delivery arrangements.

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