ECE User Account Form

Please print plainly in all required fields.

Name:   ________________________________________________________________________
(as printed on your LOBO card)

Department:     _________________________________________________________________
(EE or CE)
Faculty, Class Instructor, or Graduate Adviser:        ____________________________________
(For students not accepted into our department or graduate students)

E-Mail Address: ______________________________________________________
(UNM or other email address)

Phone Number:   __________________________________________________________
(For other contact issues if necessary)

Account Type: (check one)
___ECE Major Student
___Class Account Only (Undergraduate not accepted in our department)
___Graduate Student
___Post-Doctorate
___Researcher
___Faculty
___Staff

Please enter your first choice for a user name:   _______________________________________
(Use six to ten alphanumeric characters)

Please enter a second choice for a user name:   _______________________________________
(Use six to ten alphanumeric characters)

Account holder signature:      ____________________________________________________
(your signature indicates you have read and understood the ECE Department
acceptable use policy)

Date:   _______________________________________________________________________

Faculty, Class Instructor, or Graduate Adviser signature:      ________________________________

Date:   _______________________________________________________________________

Computer Support Group Management signature:    ________________________________

Date:   _______________________________________________________________________

Account Operator signature:      ____________________________________________________

Date:   ________________________________________________________________________