Fillable Name and Network Change Form (Blackhawk Technical College)

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Name and Network Change Form (Blackhawk Technical College)

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Country of origin: US
File type: PDF

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6004 S County Rd G • PO Box 5009 • Janesville, WI 53547-5009
(608) 757-7660 • fax (608) 743-4407 • registration@blackhawk.edu
Last Revised: 12/9/2019 1
Name and Network Change Form
To have your name changed and your network login username (which includes BTC student email accounts) changed,
please complete the Student Information and Authorization portion below. At the time that this request is made, you must
present one form of official identification (i.e. driver’s license, state identification, marriage certificate, or divorce decree)
showing the name that you are requesting your records be changed to.
All of the existing data on your home directory (H: drive) on the BTC Network will be moved to the new home directory
using your new login name. Once the username change is complete, your initial password will be your 9-digit student ID.
You will be prompted to change your password the first time you log on. You will be contacted by the IT-Helpdesk within
72 hours of completion of your update.
If you have a current BTC email account, all of your emails will be transferred to your new email account. It is your
responsibility to inform your instructors of your new email address so that they can update your information.
STUDENT INFORMATION AND AUTHORIZATION
Name Change Only
Name and Network Change
Current Name
BTC Student ID Number
Current Network Username
New Name
Contact information to notify when request is complete:
Personal Phone Number
Personal Email Address
I have read and understand the information as stated above:
______________________________________________________ ________________________________
Student Signature Date
FOR OFFICE USE ONLY
REGISTRATION AUTHORIZATION
ID Verified, indicate type:
Verified By
Date Verified
New Login:
ITS WORKFLOW
New Email Address (if applicable)
New Network Login
Effective Date
ITS Initials
Work Order Number
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Name and Network Change Form (Blackhawk Technical College)

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Completed 27 July 2020

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