Telephone and Internet Service Request

Guest Telephone and Internet Service Request – Department/Sponsor

If you are sponsoring Guest telephone and/or Internet service for an event on campus, Please complete the form below and submit to UIS. If you have questions filling out this form, please call the UIS Help Desk at 740-351-3538.

Request Details

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

Add More Locations

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

SSU Host/Booking Information

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 Technology Fee Schedule.

Name

Department

Requestors Signature

Department Approval

Breadcrumb

Telephone and Internet Service Request

Guest Telephone and Internet Service Request – Department/Sponsor

Request Details

Location 1

Location 2

Location 3

Location 4

Requestor Contact Information

SSU Host/Booking Information