Department of Information Technology
2039 Kennedy Boulevard . Jersey City . New Jersey . 07305      Phone: 201-200-3350

Remote Network Access Request Form
for NJCU Faculty and Staff

Request for access to the University network
through NJCU authorized Remote Network Access software.

Remote Network Access Policy and Procedures:

(Please read Remote Network Access Policty and Procedures (.pdf) and check the box shown below to indicate you agree with the all of the content within the document, which is required by NJCU.) 


* By checking the box provided, you agree with and accept the Remote Network Access Policy and Procedures as stated in the linked PDF file.

* Applicant Information

ALL ANSWERS ARE REQUIRED.

 
*Provide your answers below.
Name
Title
Company
Telephone number
Remote Location
Internet Service Provider
Computer Make / Model
Anti-Virus Software
Anti-Virus Version
Anti-Virus Datafile Version
* Applicant's Information

ALL ANSWERS ARE REQUIRED.      (A copy of this application will be sent to the "Applicant's" email address.)

 
*Provide your answers below.
Applicant Name
Applicant Email Address
* Supervisor's Information

ALL ANSWERS ARE REQUIRED.     (A copy of this application will be sent to the "Supervisor's" email address.)

 
*Provide your answers below.
Supervisor Name
Supervisor Email Address
* For use on NJCU University Computer?
REQUIRED FIELD.


If you encounter any difficulties, please contact the Help Desk at helpdesk@njcu.edu
. Thank you.