Request for IT Help

Personal Information

Full Name:
Full Email address: (For example: username@rice.edu)
Phone:
Location of your computer (building & room):
Problem Severity:

Courtesy Copy (cc)
Please enter the email address of another individual who should be notified of all updates to this ticket.
Full Email address:

Request Details

Summary Description
Enter a one line summary of the problem:

Full Description
Please describe your issue in as much detail as possible. Helpful information would be:

Type of machine (Mac, PC, etc.)
Operating System (OS 10, Windows XP, etc.)
Software and version (MS Word 2003, etc.)
Specific Error messages (copy & paste if possible)

Appointment:

I permit you to work on this issue even when I am not in my office.

I would like to be present when you work on the service request (please contact me for a date and time).

I would like to request an appointment at . I am also available at if the first appointment time is not good.

Select to send in the completed form.

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	I permit you to work on this issue even when I am not in my office.
	I would like to be present when you work on the service request (please contact me for a date and time).
	I would like to request an appointment at . I am also available at if the first appointment time is not good.