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Community College of Rhode Island

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Campus Domain Account Application Form

Return signed form to: The Department of Information Technology, attn: Help Desk.

You must fill this form out before you print it. Return it to: The Department of Information Technology, attn: Help Desk. Thank you.

Please provide the following information: (Please Type)




*Your CCRI ID# is the 8-digit number below your name on your Faculty/Staff or Student ID.









Faculty - full-time  Adjunct Faculty - part-time  Lecturer
Staff - full-time  Staff - part-time  student**
**Student accounts are terminated at the end of the current semester.

yes - termination date:
no
Domain
Access to Share Drive  
For email  

Agreement: I have read, understand, and agree to comply with the CCRI Data Security Policy and the CCRI Policy on the Responsible use of Information Technology. I understand that I am responsible for any computing activity carried out using this account.

Routing: (This is the only area to be filled out by hand.)

Applicant's Signature: _________________________________ Date: _____________

Department Head's Signature:____________________________ Date:_____________

IT Use Only: Date Acct. Created: _____________  Acct. Termination Date: __________ Initialed:_________

Remember! You must fill this form out
before you print it. Thank you.


Last Updated: 5/31/16