Employee Account Request

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First Name*

Last Name*

Personal Email Address*

Last 4 Digits of SSN*

Department*

Employee Classification*

Adjunct Faculty

Full-Time Faculty

Staff

Instructor NumberIssued from the registrar if applicable.

Campus Location

Hope

Texarkana

James Black School

By submitting this form, I acknowledge and agree that I have read and understood the Computer Services Resources Policy and the rules that are contained within.

I Agree