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 Email (if applying for a new account): ______________________________________

RCI Username (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 these documents is available at: http://rucs.rutgers.edu/acceptable-use.html). Each year you will be contacted via email 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" from the NBCS Documentation home page at: http://www.nbcs.rutgers.edu/newdocs/).

Signature: _______________________________________ Date: ______________________

Part II: (To be completed by the sponsor)

First Name: ___________________________ Last Name: _____________________________

Department: _____________________________ Job Title: ____________________________

Campus Address: _____________________________________________________________

Email Address: _____________________________ Campus Phone #: ___________________

I request a guest account for the following person: ____________________________________

Allocation period (how long should the account be active): ______________

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://policies.rutgers.edu/PDF/Section20/20.1.8.pdf)

How will the account be used? (Please be as descriptive as possible, i.e. email, 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 email 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 Dean, Director                              Print Name                              Date
or Department Chair (if different from Sponsor)