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Network Account Request Form
Section 1 - Requestor Information
Name of Guest: *
Guest Contact Email: *
Relationship with Baldwin Wallace:
Reason for Account:
Account Start Date: *

Account End Date:

Account Type: * Network/Email LMS Access * Shared Drive *
Please provide justification for any items selected that are denoted with a blue asterisk (*)
Account Type Justification:
Requested Account Name: * (up to 8 characters)
Requestor's Phone Number: * (Phone Number Format ###-###-####)
Department Chair Name: *
Department Chair Email: *
Click Submit to send request to listed Department Chair. If you are the Department Chair then click HERE for immediate sign off.