Fillable Authorization Form (Central Connecticut State University)

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Authorization Form (Central Connecticut State University)

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COPY CENTER ON-LINE
USER AUTHORIZATION
FORM
This form is used to grant approval to use the Copy Center On-Line
Program. Once you have completed this form and it is signed by your
department head, please return to Lucy Cannamela by mail to MW
Annex room 006 or fax to X22522 and you will be added to your
department’s list of authorized users to use the Copy Center On-Line
Program.
First Name:
Last Name:
CCSU BlueNet
Account Username
Extension:
Department
Building/Room
Approval to use the Copy Center On-Line Program is granted.
___________________________________ _________________
Signature of Department Head or Designee Date Approved
_________________________________________
Printed Name of Department Head or Designee
PLEASE ALLOW UP TO TWO WORKING DAYS FOR ACCESS TO BE GRANTED
********************************************************************************************************************
Special Note:
To use the Copy Center On-Line Program you must have a CCSU
Blue Net account. Forms to request this account are available on the
Information Technology Services website at
http://www.ccsu.edu/page.cfm?p=332
Rev. 10/10
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Completed 22 July 2020

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