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Community College of Rhode Island

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Campus Domain Account Application Form

Please print the form, complete it and return it to: The Department of Information Technology, attn: Help Desk

Please provide the following information: (Please Type or Print Clearly)




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

Domain
Access to Dept. Share Drive
Other

yes - termination date:
no

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:

Applicant's Signature: __________________________________________ Date: _____________

Department Head's Signature:____________________________________ Date:_____________

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

Last Updated: 1/7/16