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.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.

Note: Renewals of guest accounts require only the signature of a department chair, designee or sponsor.

_____________________________________________________________________________________
Signature of Sponsor                                             Print Name                              Date

_____________________________________________________________________________________
Signature of Department Chair or Designee              Print Name                              Date

_____________________________________________________________________________________
Signature of Guest                                                 Print Name                              Date
(Proxy signatures are allowed when guests are otherwise unavailable to sign the form, e.g. overseas or similarly unable to sign in person, and provided the guest has verified s/he will abide by the Acceptable Use Policy)