Request for E-Net User Name & Password

Please fill out all of the information requested below for a copy of your E-Net User Name and Password. Please allow 3-5 business days for processing.

Date:    

Name : 

Student ID#:

Major:

Advisor:

Student's Current Address (Be Sure to include apartment #s):

Student's Daytime Telephone #:

Student's Evening Telephone #:

Voice Mail Box #:

E-mail Address:

Campus Mail Box #:

Please Note: If no campus mail box is given, information will be mailed to the Permanent Address or Local Address on file with the Office of the Registrar.

Class (i.e. Junior) or Program (i.e. Undergraduate, Graduate):