Request for Telephone and/or Computer Service for New Employees and/or Relocating Employees

Current office: Bldg. / Room #		New Office: Bldg. / Room #
(i.e. bldg/ rm # 5 - 103)		(i.e. bldg/ rm # 5 - 103)

Date move is scheduled to take place:
	(REQUIRES 10 DAYS NOTICE)

Please check all equipment choices that apply to the move:

Telephone & Computer   Local Printer   Network Printer   Scanner

Please check all that applies and fill in where information is needed:

New MCC Employee   Employee Changing Department

Relocate from Damon to Brighton   Relocate from Brighton to Damon

Does Department affiliation need to be changed?
If yes New Department Name

Reassign Extension   Assign new Extension

Full-time   Part-time   Adjunct

Bldg. / Room #

(i.e. bldg/ rm # 5 - 103)

Date Service is needed
	(REQUIRES 10 DAYS NOTICE)

Do you want Voice Mail on telephone? Yes   No

Type of calling: Local   Long distance  Internal calls only

Is there a computer in the office?

Yes - Provide decal number No PLEASE NOTE: If one is needed, Department must request a Cascaded PC from Bob Cunningham

Will you need CNS to rebuild computer for new employee? Yes   No

In the box below please write in any additional information that would be helpful to the CNS staff for processing your request:

When form is completely filled in, print it using File, Print off the menu bar at the top. The form should then be forwarded to your department head for signature and mailed to CNS/Telecommunications Department.

Signature of Department Head:

_______________________________________