Revised 3/2014
CCSU Information Technology Department
BlueNet Account Request Form for New Employees
A BlueNet Account is a unique username and password required to access University computing services. With your
BlueNet Account, you will receive access to the campus network, a CCSU e-mail account, and personal network file
storage space. To request a BlueNet Account:
1. Complete Sections 1, 2 & 3. Have your supervisor sign Section 3 (a supervisor's signature is required).
2. Return this form to the Information Technology Department, located in Henry Barnard Hall, Room 019.
Alternately, you may fax it to us at 860-832-1730. When your account has been created, either your supervisor or
department secretary will be notified, and you will be provided with instructions for how to activate your account.
Please note that your BlueNet Account cannot be issued until all required paperwork is complete and processed by the
Human Resources Department. It may take up to a week for your BlueNet Account request to be processed. If you have
any questions, please contact the Information Technology Help Desk at 860-832-1720.
Section 1: Employee Information
Employee Type: Full-Time Part-Time Student Worker Other: _________________________________
Name (Last, First):
______________________________________________________________________________
8-digit University ID:
______________________________________________________________________________
Title/Position:
______________________________________________________________________________
Department: ___________________________________ Campus Phone: __________________________
Section 2: Request for Additional Access No Additional Access Requested
Additional Access Requested. Please specify any additional access (such as access to departmental file shares, web
editing, or other network resources) here:
Section 3: Supervisor Authorization (Required)
Supervisor’s Name (Print):
Title: ____________________________________
Supervisor’s Signature:
Information Technology Use Only Date Processed: __________________ Processed by: _______________________
Client’s Username: Exchange Account Created: File Share Created: Welcome Kit Sent:
