F0033_A, Special Services Request Form

Network Engineering and Technology
F0033_A
Special Services Request Form

Instructions - PLEASE READ - Updated June 20, 2008

This form is to be used by departments requesting special services on the GMU Network. Standard Data network service is a 10/100 Mb RJ45 connection on the Protect Network. For a definition of the Protect Network see http://tsd.gmu.edu/net/FAQ/. Upon completion, this form should be faxed to Network Engineering at 703-993-3505. All areas in bold italics print are required. Text in green are hyperlinks to policy pages or definitions for terms used on this form and why they are required.

Requesting Department:

Location:

Coordinator:

Coorinator Email:

Coordinator Phone:

Type of Data Network Connection:

RJ45	LC	SX	Don’t Know
SC	LX	ZX	Other, please specify

Additional Connection Type information:

Special Requirements

Select all that apply. If an item is marked "Yes" then the Contact Information must be supplied.

	Contact	Phone	E-mail
Credit Card Yes No
Firewall Yes No
Labs Yes No
Wireless Yes No
Servers Yes No	Please complete F0014_A for each server
Other, please specify Yes No

Additional Information for Special Requirements

This form will print when submitted. Please fax signed forms to 703-993-3505. this form so that a tracking ticket can be created.

If necessary, use this button to

Network Engineering & Technology
George Mason University
Thompson Hall, Mailstop 1B5
4400 University Dr.
Fairfax VA, 2030-4444

Fax: (703) 993-3505

Page Updated: June 20, 2008