Residence Hall Network Connection Agreement Form


Name______________________________________________ Date ____ / ____ / ____


Dorm _____________________________________  Room# _____________________


Phone# ________________  E-mail Address: __________________________________


All Residence Hall Network Connections completed in Fall or Winter Quarter will be disconnected prior to the start of the Summer Quarter. If you are staying in the Residence Hall during the Summer Quarter you must complete a new Residence Hall Network Connection Agreement Form. Summer Quarter connections are disconnected following the end of the second Summer session.
Please read the following information carefully and sign at the bottom.

The use of computer resources at Andrews University is a privilege and responsibility to be used appropriately.  The following inappropriate uses of a computer network connection include, but are not limited to:


1.     Illegal actions such as:

a.       Attempting to gain unauthorized access to data, computer accounts or systems

b.      Illegally copying or distributing licensed or copyrighted software

c.       Malicious attempts to damage data, software, or hardware

2.     Using the computer or network in such a way as to intentionally impede the computing activities of other users (off-topic or blanket posting to newsgroups or listservers, excessive mail, filling all disk space, tying up computer resources for excessive game playing, etc.)

3.     Using derogatory or profane language in electronic communication

4.     Harassment of other users through electronic communication

5.     Using computer accounts other than those assigned to the user

6.     Giving a computer account password to another person or enabling others to have unauthorized access to a computer system


I have read the above statement and agree to refrain from using my network connection inappropriately.


Applicant Signature: ___________________________________________________

Network Configuration - TCP/IP Properties IP Address:
DNS Configuration: 143.207.___.___
Host:_______________ Subnet Mask:
DNS Server Search Order:
Domain Suffix Search Order: Gateway:
For Office User Only

Sales Rep. ______________  Connect Fee: _____________  Date ____ /____ /____   DNS Entry Initials ___________


Completed Date: ____ /____ /____ Technician: __________________                               Original: ITS          Copy: Customer