Information Technology Division
MTSU E-Mail Account Request Form
(For Certain Employees)
Access to the public Internet is automatically granted when an account is created. Computer usage is
subject to the Information Technology Resource Policy of Middle Tennessee State University
and state and federal laws. Any improper use of computing resources can result in the loss of
computing privileges and criminal prosecution in the State of Tennessee. Complete this
application and route it to Information Technology, Cope Room 003 Fax (615)898-5720.
Please Print:
M#
Name:
Last
Name Change
First
Pre-Employment Request
M.I.
Adjunct Faculty
Graduate Assistant
Other__________
Add my new e-mail address to the Subscribers@mtsu.edu list (University-Wide E-Mail Dist. List)
Department:
Full Campus Phone Number
Campus Physical Mail Box Number
Signature of Requestor
Date of Request
For Information Technology Division Use Only
Username:
Information Technology Division
UID:
Password:
Date:
Revised September 2010