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User Access Request Form

Please complete all appropriate fields below and click the "Submit" button to request access to the Coeus system. When you fill out and submit this form, it will send an email notification to coeushelp@purdue.edu as well as send a confirmation to the user's email address. It will be your responsibility to notify your technical support staff if necessary.

* Indicates Required Field
Requester email: *
Requested action: * What's this?
Access type: * What's this?
User type: * What's this?
User Information
Last Name: *
First Name: *
Middle Initial:  
Email: *
Additional comments or instructions: