UGA Network Connectivity Request Form for Non-UGA Organizations

Campus network connectivity requests by organizations not directly affiliated with the University of Georgia must include the information specified in the attached form and be submitted to the following office: 

            David Matthews-Morgan
            Associate Director, Network Operations & Infrastructure
            Enterprise IT Services
            Computer Services Annex
            University of Georgia
            Athens, Georgia 30602

Requests for network connectivity will be responded to promptly in writing.

1. Requesting Organization

Organizational Name:

__________________________________________

Administrative Contact Person:

__________________________________________

Mailing Address:

__________________________________________

__________________________________________

__________________________________________

Telephone Number:

__________________________________________

2. UGA Relationship

Please attach a statement summarizing the nature of the collaborative activities involving UGA and non-UGA personnel. If any formal document describing the relationship between the University and your organization exists, please attach a copy to this form along with the summary statement.

Include in the summary the names of the individuals currently involved in these activities who are not directly affiliated with the UGA and the name of the participating UGA unit(s).

The desired starting date for UGA network connectivity and expected termination date must be indicated.

The physical location on the premises of the requesting organization for the wiring closet to be used for the siting of network termination equipment must also be specified.

3. Network Liaison

If networking problems involving non-UGA computing resources arise, it is important for EITS to interface with a non-UGA "network liaison" who can serve as a point of contact for problem resolution. He or she will also relay notifications of network unavailability to affected personnel. Please supply the network liaison information listed below.

Name:

_________________________________

E-Mail Address:

_________________________________

Phone Number:

_________________________________

U.S. Mail Address:

_________________________________

4. Signature

I certify that the information provided in this form and all attachments is accurate and that individuals in our organization utilizing UGA resources will adhere to the described activities and to the University's acceptable use policy for computing and information resources.

Signed:

_________________________________

Title:

_________________________________