Return Completed form to:                          Application Form for UNIX User Account
UNIX System Admin                                                     Department of Computer Science
Dept. of Computer Science, Virginia Tech                                        Virginia Tech
7054 Haycock Road / Room 303                                      Northern Virginia Graduate Center
Falls Church, VA 22043

Name  _____________________________________________________ Email:_____________________________

SSN/SID#  _______________________     Phone #: ___________________________________________________

Mail Address ___________________________________________________________________________________

Check one:  ___ Faculty        ___ Student in CS Dept.      ___  Student in other majors at Virginia Tech

Department_________________________      CS Courses which you currently enroll  _____________________________

Check one:   ___  Open a new user account.  Choose one of  the following account types:
                                    ___  Permanent    ( only for faculty)
                                    ___  Regular  (student in CS Dept.)
                                    ___  Temporary (non CS major student)

                      ___  Extend an existing user account.     The account is ________________________________________
                                    ___   Regular (student in CS Dept.)
                                    ___  Temporary (non CS major student)

Desired username_____________________ (3 - 8 characters)

Initial password_______________________(change on first login, at least 7 characters which contain at least 1 number, uppercase or special characters)

Your signature is your statement that you fully understand and agree to abide by the rules as stated in the Acceptable Use of Computer Science Systems at Virginia Tech.

Applicant Signature:   ____________________________________________________      Date:   ______________

CS Faculty Signature: ____________________________________________________      Date:__________________

CS Dept. Representative Signature: __________________________________________     Date: _________________

Operator Signature: ______________________________________________________     Date: _________________