Request UW NetID

This form is for Pyschiatry Department affiliates who do not have a UW NetID but need one for access to select department resources. Requests will be reviewed for sufficient justification. Completion of this form does not guarantee provisioning of a UW NetID.

Please contact our helpdesk if you have questions about this form.

Name of person filling out this form(Required)

First Last

Email of person filling out this form(Required)

Professional email addresses only (e.g. no gmail, yahoo, aol, etc. addresses)

Is the person filling out this form the same person who needs a UW NetID?(Required)

Yes

Name of person who needs a UW NetID(Required)

First Last

Email of person who needs a UW NetID(Required)

Professional email addresses only (e.g. no gmail, yahoo, aol, etc. addresses)

Position Title of person who needs a UW NetID(Required)

Why does this person need a UW NetID?(Required)

Check all that apply

Long-term access to UWNet WiFi at WisPIC

Access to a department website

Access to department VPN

Other

Please list the department website(s) needed(Required)

Please describe what other use this NetID is for(Required)

End Date

If known, please mark the date this person's access should expire