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Please note: Fields marked with an asterisk (*) are required.
*Name of person making request:(Department Chair or Secretary)
*Requester's Phone Number:
Requester Department:
Account Extension is requested for: A Faculty Member A Staff Member A Student
*Recipient Name:
Job Title(s) if applicable:
Department(s):
Office Room Number(s):
Phone Number(s):
Required Accounts Novell Account (Campus Network Access) GroupWise Email Account IO Account (Internet from home, web pages) MyUWinnipeg Account (Theology and DCE students only)
Extend account until what date?
Comments: