Longview Independent School District

Technical Services

Request for Network Connectivity for Non-District Nodes

All of the following information must be provided before any network node (computer, printer, or other network capable device) that is not owned by Longview Independent School District may be connected to Longview ISD's data network:

Owner's Name: ____________________________________________________

Owner's Organization: _______________________________________________

Operator's Name: ___________________________________________________

Contact's Name: _______________________________________________

Contact's Telephone Number: ______________________________________

Campus at which equipment is to be located:  ______________________________________________

Room in which equipment is to be located: ________________________________________________

Equipment Type:

___    Computer

___    Printer

___    Other:  must specify ____________________________________________

Equipment's MAC Address:  __ __ __ __   __ __ __ __  __ __ __ __

Indicate the purpose for connecting this device to Longview ISD's network:

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

All network access at Longview Independent School District is governed by the current Longview Independent School District Technology Policies and Longview Independent School District's Acceptable Use Policy (AUP). It is recommended that you read all policies and agreements before signing this form. By signing this application, you are agreeing to abide by these policies.

All information on this application is true. I agree to abide by the policies dictated by Longview Independent School District.  I understand that these policies may change at any time.  I understand that Longview ISD makes no warranties about the the use of or availability of any network services nor does it assume liability for incidental or accidental damage caused by connection to the district network.  The privilege of connecting to Longview ISD's network may be revoked at any time for any reason. 

________________________________________ ____________________

Signature                                                                                      Date

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Office Use Only:

Request is: ______ Granted _______ Denied--Reason: _____________________________

Assigned IP Address: ____________________ Assigned IPX Network: _______________________________

Date of Assignment: _____________________ Authorized by: ____________________________