CUbhis - Columbia University Biomedical and Health Information Services

A red asterisk denotes a required field. Formatting requirements for a field are displayed to the right where necessary.


Requester
UNI:*
Email:*
Phone Number:	xxx-xxx-xxxx

New IP request
Host / System / Device Type:*
Operating System Type:*
If other, please explain:
MAC Address:*	xx:xx:xx:xx:xx:xx Also known as the Hardware address 12 Hexadecimal Characters: 0-9, A-F only MAC - Media Access Control How To Find Your MAC Address Tickets with invalid physical address entries will not be processed.
Manual IP Configuration:*	Yes No
	Please select "No" unless you have been informed by IT staff that you require a Manual IP. Contact 5-Help with any questions.
User First Name:*
User Last Name:*
Phone Number:*	xxx-xxx-xxxx
Department:*
Building:*
other:
Floor:*
Room:*

Details (please include additional information)

Please do not click the button more than once. After submitting the request the page will reload and a ticket number will be generated for your request. If the page does not load after clicking the button, please contact extension 5-Help.

Please note: your UNI and Password are required when submitting this request.

New IP Request