DORM NETWORK ACCESS REQUEST FORM
Return form to the Technology Office Mail Box
in Administration Building or Student Services.
Please print clearly and fill out the form completely.
Incomplete forms can not be processed.
Today’s Date:
_____/______/_____
Section A
First Name:___________________ Last Name: ____________________________
SSN:_________________________
E-mail address__________________@st.colin.edu_
Phone Number: _____________________
Section B
Dorm Assignment (Circle)
1) Stevens 2) Stevens Annex 3) Copiah 4) Ellzey 5) Ellis Apts
6) Franklin 7) Simpson 8)Triplex 9)New Boys Dorm A 10)New Boys Dorm B
Lincoln Hall is scheduled for demolition;
network access will not be available from this location
Room Number: __________
__________ I need assistance installing hardware ($15.00)
If you need help please contact 643-8488 to
arrange time for install.
Section C
Desktop Laptop
Operating System:
(Please check all that apply)
_____Windows 95, 98, Me, NT, 2000, XP (circle version[s])
_____Macintosh OS Version________ (Please fill in version)
_____Unix/Linux __________________(Please specify type)
_____Other:
Network Board Information:
MAC (Adapter) address:
____:____:____:____:____:____
Without this MAC address you will not be able to
get on the network. Be sure not to provide the PPP adapter address, which begins
with 44. Instructions to help you find your MAC address are included with your
information packet and can also be found at:
http://www.colin.edu/helpdesk/findmac.htm . If you have problems contact the
Technology Office at 643-8488 and they can assist you.
By completing and submitting this form I agree to abide by all usage policies governing the Copiah Lincoln Community College networks. http://www.colin.edu/internetpolicies
___________________________________ (please sign) ____________(date)