(click the Reset button to clear the contents of the form)

Requestor's Information
(technical support staff member's information in case there are questions about your request)
Name:   

E-mail Address:   

Office Phone Number:   

Building:
(full name of the building housing the device that will use the requested static IP address)
Room Location:
(room number where the device will be located)
Jack Number:
(network jack number the device will be connected to)
Full Host Name:
(full DNS name of the device, such as "TH-121.iowa.uiowa.edu" or "GEOS-S098.iowa.uiowa.edu")
Device Description:
(descriptive information, such as "HP LaserJet 4250DTN printer" or "Windows 2008 Server")

Additional information that may be needed:

(any additional information regarding this request that may be needed)


(click the Submit button to send your request to the UI Hostmasters)