Instructions - PLEASE READ - Updated June 20, 2008

This form is to be used by any group wishing to request a wireless local area network be installed by ITU in their area/building. Completing this form does NOT guarantee approval, but starts the approval process. All fields on this form are required. Once the form is completed, print, then submit and have the Department Head sign the printed form, then fax the form to Network Engineering at 703-993-3505.

Department: Building Room /Area

Department Contact

Name E-mail Phone

Reason for Wireless

As a department head for , I am willing to pay for the installation of a Wireless Network.

I understand that in the case of a security issue, this Wireless LAN may be shut down until the machine behind the access point can be assesed, quarantined, and remediation has been completed as accepted by University guidelines.  

By signing this form, I also affirm that I have read and understand this form. I also understand that if any information is missing or improperly filled out, it may delay approval/deployment.

Department Head:

Date: ___/___/____

Signature: ____________________________________

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

IIf necessary, use this button to .