Paging Access Form

This form is to be used to Add or Remove a person or function from the Paging Database or Change their information. When you click on Submit, a form with the information you entered will be displayed. If the form is correct, print it, add any remaining information and send it to P.O. Box 800290. If you wish to make changes, use the Back button.

*Pager Owner's Name:**		Owner's UVa Computing ID (e.g. mst2k):
or
Function:

Reason for Request:

Outside pager #:

Pager Company:

(If Other):

Physician Type:

(If Other):

Dir Code:

Dept Name:

If this user is paid by the Medical Center (PeopleSoft):
PeopleSoft Code:		Division Code:

If this user is paid by the Academic Side (Oracle):
Project:		Task:		Award:		Organization:

Your Department Manager's Computing ID:

Manager's phone #:

Add cross references for published directory:
Dir Code:		*Function or Name:**
Dir Code:		*Function or Name:**

* Names should be entered as 'last, first, middle, suffix'.