BX Static/DHCP Network Connection Request Form

See bottom of page for explanation of each field.

Owner/Requestor/Primary User: (required) Email: (required)

Designated System Administrator: (required) Email: (required)

Ethernet MAC Address: : : : : : (required)

Requested DNS Hostname: .bx.psu.edu (optional)

Manufacturer: (required)

Model: (required)

Operating System: (required)

Ownership: (required)

Notes / Comments: (optional)

By submitting this Network Connection Request Form, you agree that you have reviewed the CCGB/BX's Network Security Policy, available at:

http://wiki.bx.psu.edu/BX:Network_Security_Policy

It is the responsibility of the Designated System Administrator to ensure compliance with University and CCGB Network Security Policy. The device must be in compliance regardless of ownership!

By clicking Submit you agree that you have read and will abide by all applicable University policies as described above.

Key

Owner/Requestor/Primary User: Person making the request, owner of the machine, or person that will be using the machine the most and hence responsible for it
Designated System Administrator: Individual responsible for maintaining the machine as described in the BX Network Security Policy. This CAN NOT be the CCGB/BX System Administrator unless the machine will be fully integrated and centrally managed. BX IT staff will not be responsible for machines that we don't have full control over!
Ethernet MAC Address: Hardware ethernet address of the interface you will be connecting to the network with.
Requested DNS Hostname: Unmanaged machines on the network that are assigned a static or DHCP address will have a DNS name of the form unmanaged-128-118-202-N.bx.psu.edu unless a different name is requested.
Manufacturer: Who the computer is made by
Model: Model, Service Tag, or Serial Number. Some way of identifying the computer.
Operating System: Operating system
Ownership: Who owns the machine or who purchased it.