IP Address Application Form - Staff Only

This IP address application form allows you to register a new PC or other network appliance for a network address, in order to connect it to the campus network.

Please contact ITS Help if you are unsure of how to complete any part of this form, in order to avoid a delay in registration. Non-staff members must have this form filled out on their behalf (see below).

Personal Details of staff member completing this form

To apply for a network IP address you MUST be a current member of University staff.

If this is not the case then you will need to get your departmental IT supporter or supervisor to apply for the IP address on your behalf.

* Indicates required information

I am a current member of University Staff (as defined above).*

University Username:*

University Email Address:*

Full Name:*

Department:*

Phone Extension:*

Personal details of user requiring IP address (if different from above)

Email Address:

Full Name (first-name surname):

Department:

University Status:

Phone Extension:

Connection Details

Type of Equipment to be connected, (please select from menu)*

(Type here if other selected):

If possible please include your computer IP Address and hostname below, for details please see Obtaining your network addresses from your PC .

Hardware/Ethernet/MAC Address of equipment *

Machine Location - Department:*

Machine Location - Building:*

Machine Location - Room Number:*

Is this an application for a new IP address ?*

Yes, this is an application for a new IP address (i.e. an extra PC on the network).
No, this is an application for a replacement IP address (please enter old PC details in the box below).

Please give any further information below which you think helpful to the application (e.g., hostname of old PC to be replaced by this one):

Usage of the IP Address assigned is bound by the Acceptable Use Policy. Once your machine is connected to the network it is important that your machine is fully updated and protected against viruses. Full information can be found on our More Help - PC Security . Submission of this form is an agreement to abide by these rules.

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