Web Page Application

Type of Account:  Department Employee/Staff Faculty Organization                       Other 

Department and/or Organization Name
    

Primary Contact Information

Primary Contact information is defined in the Policies.

     Name of Chair, Dean, Director, OR if it is a PERSONAL page YOUR NAME:
    

     DragonID/TechID
    

     Email
    

Check if Primary Contact needs a User Account.  Yes

Person(s) needing access to edit this web.
Include Name, Email Address, Tech Id, and Classification (i.e., student, staff, faculty):
   

  By checking this box and submitting this application I have read and agree to the MSUM Web Site Standards and Policies for WWW.

(If this form will not Submit on-line please print and deliver to the Information Technology Department.)