Dental Informatics Account Request

This form is intended to provide information to Dental Informatics in order to assist UofL's IT Security & Account Management unit with the creation or removal of the University of Louisville School of Dentistry staff, faculty or sponsored accounts. While processing of this request will occur upon receipt, please be advised that it may take 1-2 weeks for all services requested to be enabled.

Account request form

1. Your information

Your name *

Your email *

Your phone number

2. Account request type

Type of request *

3. Account applicant's previous UofL information

Has the user for which you are requesting an account (the account applicant) ever been enrolled or employed by UofL? If not, please proceed to Section IV. (optional)

Yes

Account applicant's ULINK username (if previously enrolled/employed)

Account applicant's User ID # (if previously enrolled/employed)

4. Account applicant's information

Start date of individual in need of account

Start date of individual in need of account: Year

Start date of individual in need of account: Month

Start date of individual in need of account: Day

Account applicant's first name

Account applicant's middle name

Account applicant's last name

Account applicant's position title

Account applicant's date of birth

Account applicant's date of birth: Year

Account applicant's date of birth: Month

Account applicant's date of birth: Day

Account applicant's supervisor

Account applicant's department

How long should the account be available?

Please select each resource needed (optional)

SharePoint

Blackboard

axiUm account

Please provide details of the intended use for this requested account and any other information that would be useful to Dental Informatics in the creation of the end user's account

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

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Dental Informatics Account Request

Account request form

1. Your information

2. Account request type

3. Account applicant's previous UofL information

4. Account applicant's information

Dental Informatics Account Request

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Account request form

1. Your information

2. Account request type

3. Account applicant's previous UofL information

4. Account applicant's information