First Name

Middle Initial

Last Name

Title

Department

FOAPAL

Office Location

Phone

Mail Stop

Employment Status
Full-Time Faculty Adjunct Complementary Staff Operating Staff PAT Staff

For Adjunct Faculty Only:
Please provide alternate email address so HelpDesk can contact new employee with NetID, password and instructions on how to access their KSC email.
Alternate Email

This employee
Requires a new computer
Will be assigned a computer previously assigned to another employee
Will share a computer with other employees
I don't know what arrangements have been made.*
*Contact the HelpDesk at 603-358-2532 to discuss arrangements for computer assignment.

If the new employee will be using an existing computer, to whom was the computer previously assigned?

KSC Bar Code of Existing Computer

Date Employee Starts Work

If employee is a current or former KSC student, please provide his/her NetID (username)

Name of person completing this form

Email of Person Completing this Form

What distribution lists or security groups should the new employee be a member of?

Comments or Questions