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Group Account Request Form

Brock University
Department of Computer Science
Group Account Request Form


Course: __________________________________________
Group Number: ______________ (if assigned)
Group Leader: __________________________________________
Student Number: ______________ (group leader)
Brock Email: __________________________________________
Alternate Email: __________________________________________
Contact Number: ____________________
Student Num Username Signature
_____________ _____________ ___________________________________________
_____________ _____________ ___________________________________________
_____________ _____________ ___________________________________________
_____________ _____________ ___________________________________________
_____________ _____________ ___________________________________________
_____________ _____________ ___________________________________________
_____________ _____________ ___________________________________________

Date of Application: _________________________
Signature of Applicant: ____________________________________
Instructor's Signature: ____________________________________

In signing this form I acknowledge that I have read and that I understand the Computer Science Department Policies (available on the department's Web Server: http://www.cosc.brocku.ca/ ), and I understand that failure to comply with these Policies will result in the loss of my user privileges.