Application for a Network Identity (Form 70)
Please print this form and return to CIT HelpDesk, Cornell University, 119 CCC, Ithaca, NY 14853
Be sure to enclose a photocopy of your valid Cornell ID Card or a photocopy of a valid government-issued photo ID card (such as a driver's license or passport). Your network identity (NetID), your activation code or temporary password, and general information about using your NetID will be sent to you upon completion of this request.
| Name (First, Middle Initial, Last): | ||
| Social Security Number: | ||
| Department: | College or Unit: | |
| Status (please circle): Undergraduate -- Graduate/Professional Student -- Faculty -- Staff -- Other | ||
| Campus Address: | ||
| Address Where You Receive Mail: | ||
| City: | State: | Zip Code: |
| Telephone Number (with Area Code): | ||
| I, the undersigned, having read the Policy Regarding the Abuse of Computers and Network Systems (Policy-1) and the Terms and Conditions Governing the Use of CIT Network IDs (Policy-9), agree to abide by the terms and provisions stipulated therein. | ||
|
Signature: |
Date: |
|
Related link: Frequently Asked Questions about Network
IDs
Questions about this form may sent via e-mail to
helpdesk@cornell.edu, or you may
phone 607-255-8990.