Request for a Personal Web Account

Name:

Faculty -- Department
Staff -- Position
Student -- Student Number

Phone Number: Home Work

Marywood.edu E-mail address: (required)
Note: Your request cannot be processed without this address even if you do not use this account for e-mail.

Alternate E-mail address:
(if you wish to be contacted at a different e-mail address)

I have read Conditions of Computer Use, the Web Pages Policy and the Guidelines for Faculty, Staff and Student Personal Web Pages and agree to abide by their provisions.

Signature: __________________________________________________

Date: ________________________