USER SERVICES REQUEST FORM (**Telephone Support only**)
COAST COMMUNITY COLLEGE DISTRICT
DISTRICT INFORMATION SERVICES

* = Required field (must contain an entry)

DATE:
  

Last Name:*  First Name:* Email:*
Campus:* Your Phone #:*
Department:* Building/Room:*
Work Hours: to , to
EQUIPMENT (Check all that apply)
  
Telephone Number:* Other: Telephone Numbers:
Telephone Type: 8403 Fax
8410 Modem
8411 Emergency Phone
Voicemail
Description of work and date needed:*

  
Account # to be charged (if applicable):

NOTE:  This form will be sent to the DIS Help Desk, ext 84618.
 

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Comments or questions: rpatterson@mail.cccd.edu