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E-Mail Account Request Form: PART A: To Be Filled by The USER

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E-Mail Account Request Form

Completed Forms Should Be Returned To:


ICT-Center, AUST (Room # 7B04) or
Email to: ictc-hs@aust.edu
(Allow 3 Business Days for Processing)

Please Print or Type All Information Clearly


(Illegible and incomplete forms will not be processed)

PART A: To be filled by the USER


Title:  Mr.  Dr.  Mrs.  Ms.  Faculty  Staff
First Name: Last Name:

Department/School/Office Job Title: Room


No.
Requested Email Address
E.g. xyz.cse@aust.edu
Contact No: User’s existing email
E.g. xyz@yahoo.com
 In signing below, I agree that I will maintain the privacy of my user ID and password and that I will not enable another person to
access information using my account. This account will automatically be deleted upon my termination as an employee or account
inactivity of six months.

User Signature: Date:


(dd/mm/yyyy)
 It is recommended to change the given password after your first login.

PART B: To be filled by the Head of the Department/Office


 Please give the above user an access to our aust.edu mail server.

Signature & Name Stamp and Date

PART C: To be completed by ICT-Center


Email ID (default is first letter from first name.last name.dept/office):
USERNAME: PASSWORD:

GIVEN BY:

Name Signature Date

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