PsyIT Department of NYSPI- ONLINE REQUEST

VPN Request Form:

The sole purpose of a NYSPI VPN account request is to give access to the NYSPI internal network resources. If you have a Columbia UNI and do not need NYSPI internal network resources, please contact the Columbia help desk at 212.305.HELP to request a Columbia network access VPN account.

Please note this: once you submit the form, your supervisor will receive an automatic email asking for a confirmation. Please type in your supervisor's full name and email address correctly. Your request will NOT be processed until your supervisor approves your request.

Upon supervisor's approval, the case will be logged into the PsyIT Help Desk System and your supervisor will receive a case number. To check on the status of your request, please contact your supervisor.

Items with * are required.

Requested by: (If requested by a third person) *
Requestor's email address: *
APPLICANT INFORMATION
First Name: *
Last Name: *
Work E-mail Address: *
Columbia UNI:
Title: *
Department: * If Other, please specify:	Other:
Location: *
Work Phone: *
Work Fax: *
Employed By: *	RFMH Columbia NY State
Expiration Date:(mm/dd/yy) *
Supervisor's Full Name: *
Supervisor's Email: *
IT Person's Full Name:
IT Email Address:
Operation System: *
Reason to Request: *