City of Stamford Technology Department

Account Modification Form - City Employees

First Name:

Last Name:

Please enter the email addres of the employee whose account is being modified.

Email Address:

New Job Title

New Location

New Network Access Needs

Is this employee replacing another person who is leaving this department?

Yes

Please indicate the outgoing employee:

Specify New Job Title here:

Please detail on the new location:

Business Phone Number

Network Resources such as Folders or Shared drives:

Comments?:

Approver's Business Phone Number

Approver's e-Signature

First Name

Last Name

Choose how to sign

Draw Type