Department of Computer Science and ICT
ICT Service Request Form
Full Name:
*
First Name
Last Name
Office/Location
*
Equipment/Service Name:
*
Serial No.:
Model:
Phone Number:
*
E-mail:
example@tharaka.ac.ke
Request Date
*
-
Day
-
Month
Year
Date
Type of Service Requested
Please Select the Suitable Option
Desktop Computer/Laptop
Network (Internet, Intranet)
Printer/ Photocopier
System(s) (ERP/Navision, Library)
User Accounts (Email/ Portal(s)/ E-Learning/Off-Campus/Library/Active Directory/Wi-Fi Access)
Technical Specifications
Others (Please Specify)
For Other(s):
Request Description
Signature
*
ICT SECTION - FOR OFFICIAL USE
ICT Support Officer:
First Name
Last Name
Service Provided:
Type a question
Yes
No
Date
-
Month
-
Day
Year
Date
Save
Submit
Print Form
Should be Empty: