Desired network name (3 choices)

Building (Moore or McCullough)

Room (location of computer):

Type of computer (Mac, PC, Printer):

Brand of computer:

Laptop

Operating System:

Group or Advisor:

Name:

E-mail:

Computer Hardware Address:

Computer Wireless Hardware Address:

DHCP

Roaming (Laptops only)

Jack#:

Port (top left, top right, etc.)

Phone#: