Academics Future Students Current Students Faculty/Staff Alumni/Friends Parents

  Home > Offices > University Information Services

Shawnee State University, University Information Services Telephone and Internet Service Request


Please fill out the form below completely. If you have problems filling out this form, please call the UIS Help Desk at 740-351-3538.


 

Provide a brief description:

Confirmation Number:

 
Request Date:
Event Title:
Event Day(s)/Time(s):
Setup Day(s)/Time(s): 
   
Location 1:
Number of Data Ports:

Number of Phone Ports:
   
Location 2:
Number of Data Ports:
Number of Phone Ports:
   
Location 3:
Number of Data Ports:

Number of Phone Ports:
   
Location 4:
Number of Data Ports:

Number of Phone Ports:
   
Technical/Network Support (Indicate Specific times and type needed):
Requestor Contact Information:
   
Name:
Address:
Daytime Phone Number:
Evening Phone Number:
Email Address:
Signing this agreement signifies that you agree to all terms and charges associated with the Telephone and Internet Service Request Form. In case of cancellation within 24 hours of the event, UIS reserves the right to charge for any or all costs incurred. Detailed information on regarding services and fees can be found on the Phone and Internet Connectivity page.
   
   
SSU Host/Booking Information
   
Name:
Department:
Requestors Signature:
Department Approval: