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The University of Texas at Austin

Copier Authorization Request Form

Today's Date: 07/24/2008

Desired 6-digit code

This number will be your code stem. Your actual copy code will prefix this stem with 1, 2, 3, 4, or 5, depending on the type of account used.

Name

Email Address

Job Title

Office Location

UT-EID

Office Phone

Faculty/Staff/Visitors

1 - Administrative Authorization

Account title

Authorization expires

Chair office approval

2- Research Authorization

Account title

Authorization expires
/ /

Name of PI

3- Instructional Authorization

Account title

Authorization expires

Accounting office approval

Graduate Students

4- GRA Authorization

Account title

Authorization expires
/ /

Name of PI

5- TA Authorization

Course #

Name of Instructor