Once you have completed and submitted this form, a summary will be displayed for printing. This should be presented by you to the nominated authorising party in your section for their signature and authorisation. This original signed copy should be forwarded to ITS Client Services either via internal mail (M463) or hand delivery. Processing may begin on the details provided on the electronic copy, however requests will not be finalised until the original has been received by ITS Client Services.
Authorising UWA Unit:Username:(your username must be 3-8 alpha-numeric characters, should be based on your own name, is part of your email address and cannot be changed.)First Preference:Second Preference:Given Name: Surname:UWA ApplicantsStaff Number:Non UWA ApplicantsI am a: Visitor Hospital Staff Contact Phone: Internet access level for this account:If you need access to the UWA wireless or wired SNAP network, access through the UWA VPN, UWA proxy or UWA dial in modem pool, you will require at least restricted access. If you need access to the wider internet (beyod sites hosted at UWA) through any of those services, you will require Unrestricted access.NoneRestrictedUnrestrictedPlease send notification details via ONE of the followinginternal mail to applicant named above:MBDP internal mail care of:at MBDP email to: I have read and agreed to the Cyllene Terms of Use.I understand that the Cyllene server is for networking and related purposes only. I will not install or copy on to the system any software or version of existing software unless ITS approval has been specifically granted. I have read and agree to abide by the UWA Computer and Software Use Regulations and the ITS Cyllene Username Management Policy. I understand that users who breach the rules may be denied further access. I have also read and accept the UWA Disclaimer of Liability.NoYesAuthorisation Details:This request must be authorised by a current Authorisor.Authorisor's Name: Status of Authorisor:Head/ManagerActing Head/ManagerRegistered with ITSAuthorisor's Email:Details of this request will be forwarded to this address.
Username:
(your username must be 3-8 alpha-numeric characters, should be based on your own name, is part of your email address and cannot be changed.)
First Preference:
Second Preference:
internal mail to applicant named above:MBDP
internal mail care of:at MBDP
email to:
I have read and agreed to the Cyllene Terms of Use.I understand that the Cyllene server is for networking and related purposes only. I will not install or copy on to the system any software or version of existing software unless ITS approval has been specifically granted. I have read and agree to abide by the UWA Computer and Software Use Regulations and the ITS Cyllene Username Management Policy. I understand that users who breach the rules may be denied further access. I have also read and accept the UWA Disclaimer of Liability.
Authorisor's Email:Details of this request will be forwarded to this address.
