Please print clearly in completing this form.

Part I: (To be completed by the applicant)           New Account: _____   Renewal: _____

First Name: _________________ Middle Initial: _____ Last Name: _______________________

SS#: _______________ Birthdate(MM/DD/YY): ______________ Gender: F ______ M ______

Campus Address:________________________________________________________________________

Dept./Division: _________________________________________________________

Bldg: _________________ Room No.:__________ Campus: ____________________

Home Address: _______________________________________________________________

Daytime Phone Number: ____________________ Home Phone Number: ________________

Alternate E-mail address (if applying for a new account): ______________________________________

RCI NetID (if applying for a renewal): ___________________________________________

I agree to use this account in accordance with the Acceptable Use Policy Guidelines for Computing and Information Technology Resources (an online copy of those documents is available at http://oit.rutgers.edu/acceptable-use.html.

NOTE: Guest accounts expire on September 30 of each year.

Each year you will be contacted via e-mail to renew your account. It is your responsibility to complete and submit a new application form before the due date. (A copy of this form is available under NBCS Forms at NBCS Documentation home page at http://www.nbcs.rutgers.edu/newdocs/nbcsform.html

Signature: _______________________________________ Date: ______________________

Part II: (To be completed by the sponsor)

First Name: ___________________________ Last Name: _____________________________

Department: _____________________________ Job Title: ____________________________

Campus Address: _____________________________________________________________

Email Address: _____________________________ Campus Phone #: ___________________

Should the Guest receive official Rutgers announcements via this account? Y _____ N _____
     
If yes, please specify the following:

      (a) Type of announcements: For Faculty _____ or For Staff _____
     
      (b) Rutgers mailing code: _______

(Mailing codes are available at http://mds.rutgers.edu/distributioncodes.html )

How will the account be used? (Please be as descriptive as possible, e.g. e-mail, web pages, etc.)

____________________________________________________________________________

____________________________________________________________________________

Will this account be the Guest's only source for computing? Y _____ N _____

List Rutgers-owned machines where the Guest has account(s): _________________________

Each year, we will contact your guest via e-mail when his/her account is about to expire. If your guest wants to renew his/her account, it is his/her responsibility to complete and submit a new RCI Guest Account Application/ Renewal form according to the instructions on the form.

As sponsor, I agree to assist OIT in resolving any issues that may arise concerning the appropriateness of my guest's account usage. I also verify that my guest is performing services for my department and will use this account only for purposes that are directly related to the performance of those services.

_____________________________________________________________________________________
Signature of Sponsor                                             Print Name                              Date

_____________________________________________________________________________________
Signature of Department Chair or Designee              Print Name                              Date