Non Employee Account Request

Non Employee Account Request
Midwestern State University 3410 Taft Boulevard Wichita Falls TX, 76308

This request is for: Non-Employee Network Access ONLY

This form is a request for access to MSU Texas IT Resources for individuals who are not currently employed by the University but have a requirement (practicum student, housing student, etc) for access to MSU systems.
Name

Legal First NameMiddle NameLegal Last Name
Contact Email Address
example@example.com
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reason for Access Request
Additional Remarks
Signature
Date

MonthDayYear
Date
An e-mail notification will be sent to the responsible employee named above and the "Contact Email Address" to provide account information.

If you have any questions regarding this form, please contact the IT Help Desk at 940-397-4278.
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