Use this form to request a new UR Active Directory and/or Office 365 email account or to modify an existing account. Requests should only be submitted by supervisors or authorized departmental IT representatives. Contact InformationManager/Supervisor or authorized departmental IT representativeName* First Last Phone Number*Email Address* Department*Users in Arts, Sciences & Engineering are automatically provisioned. Contact the IT Help Desk if you require assistance with an Arts, Sciences & Engineering account.Action RequestedRequest*Create new UR Active Directory and Office 365 email accountsCreate new UR Active Directory account onlyCreate new Office 365 email account for existing UR Active Directory accountModify existing UR Active Directory accountModify existing Office 365 email accountDesired Effective Date* Date Format: MM slash DD slash YYYY Employee InformationAccount Holder's Name* First Last Phone Number*Department*Employee's Supervisor* First Last New AccountsName of a person with an existing account that this user will need similar access to First Last UsernameIf this new user has an existing account (username/ID) on any University of Rochester system, provide it here. We will try to assign the same username if possible. You may also specify a desired username.Changes to Existing AccountsChanges requested*Additional InformationOptional Comments This iframe contains the logic required to handle Ajax powered Gravity Forms.