Shared Device Software License Request
Submit your request to obtain or renew a software license for a shared device. Please provide all required details for processing.
Full Name
*
First Name
Last Name
Department
*
Please Select
IT
Engineering
Research
Administration
Other
Email Address
*
example@example.com
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Device Name or ID
*
Device Location
*
Software Name
*
Software Version (if known)
License Type Requested
*
New License
Renewal
Upgrade
Intended Usage/Justification
*
Requested License Duration
*
Please Select
1 month
3 months
6 months
12 months
Other
Supervisor/Manager Name (for approval)
Additional Notes or Special Requirements
Submit Request
Should be Empty: