Unified Clinics

IT Request Form

Please complete the following form to submit a work order for your computing needs. If you have a deadline by which the request needs to be completed, include that date with your submission.

Once the form is received, the IT coordinator for Unified Clinics/Center for Disability Services will contact you regarding your request.

Your name (required)

Email (required)

Department/Clinic (required)

Office phone (required)

Building (required)

Room or office number (required)

Reason for request (required)