Date of Request                                                                                                                                   New                Renewal
 

Organization or group name  
 

Individual responsible for the account

                             Name                         

                             Phone number        

                             ISU e-mail address   

                             University ID                       
 

Account name requested:   ISU-  @mail.indstate.edu

(All names will be preceded by "ISU-" followed by the account name. Example" "isu-oit@mail.indstate.edu")

Purpose of account  
(What will this account be used for?)

List and other individuals who will be given access to the account.

                      Name                       University ID 

                      Name                       University ID 

                      Name                       University ID 

Student organization or group requests only

Is the organization/group registered with the ISU Students Activities and Organizations Office?     Yes           No 

Faculty/staff advisor name      

Advisor phone number            

Advisor ISU e-mail address   

Will this account be used to send e-mail to persons who are not ISU students, faculty, or staff?     Yes           No  

If yes, provide details 

Revision 5                                                                                                                                                                                                                                                                                  1/19/2011