Student Services Technology & Assessment

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		Purdue University Student Services Technology & Assessment Schleman Hall, Rm. 204 475 Stadium Mall Dr. West Lafayette, IN 47907-2050 Phone: (765) 494-3175 Fax: (765) 496-1109 Email: ssta@purdue.edu

WORKSTATION TECHNOLOGY - Account Maintenance Forms

Change an Existing Account

Requestor (Departmental Coordinator)
Name:
Phone # :
Email:

Request pertains to (Full Legal Name Required):
First: Middle Initial: Last:
Alias:
Phone # :
Room # :
Department # :

Date request needed by:


Change existing account (i.e. access to directories/groups/non-person mailbox)



BE SURE TO PRINT THIS FORM BEFORE SUBMITTING IT