First Name*: Last Name*:

School or Division*:

Phone Number*: University Email Address*:

Software Information:

Title*: Version*:

Publisher*: Number of Licenses*:

Special Requirements:

Please note: One form must be completed for each unique piece of software being requested.

Media Type (select one)*:

**Web Address:

***Other Specified:

Please note: The following should be submitted to the ICT Help Desk located in EJW B-13 within two working days from the time this form is submitted:

• Original CD/Diskettes (a copy of the media will be returned to the school or division),
• Original licensing agreement (the original license will be returned to the school or division), and
• Contact information including support agreements and dates of maintenance agreements.

Installation Information*:

Computer Asset Tag Number:

Please note: The asset tag number is the six digit number found on the white sticker affixed to the computer. This number is issued by Texas Wesleyan and usually begins with "0".

Building: Ann Waggoner Fine Arts Bldg Armstrong-Mabee Business Center Art North Baker-Martin House Bookstore Boyd House Brown-Lupton Campus Center Burleson Campus Central Power Plant Dan Waggoner Hall Dan Waggoner Annex Dora Roberts Dining Hall Downtown Campus - Law School Elizabeth Means Armstrong Hall Ella C. McFadden Science Center Eunice and James L. West Library Glick House Health Science/Nurse Anesthesia Law Sone Fine Arts Center Louella Baker Martin Pavilion Maintenance Center/Security Nenetta Burton Carter Building Nicholas Martin Hall Oneal-Sells Administration Bldg Otho C. Armstrong Hall Polytechnic UMC Scene Shop Schollmaier Science and Technology Center Sid W. Richardson Center Stella Russell Hall The Dillow House Wade Hall Wesleyan Village Other Room Number:

Licensing and Technical Verification*:

Have you verified that the software named above is properly licensed and compatible with the machine on which installation is requested?

Please note: If you indicated "No", the form cannot be processed. The requestor must obtain proper licensing and verify technical compatibility with the manufacturer prior to requesting installation. For assistance call (817) 531-4428.

Dean/Supervisor Approval*:

Dean/Supervisor's Name:

Have you gained approval from your dean or supervisor to request this software installation?

Please note: If you indicated "No", the form cannot be processed. The requestor must obtain permission from his or her dean or supervisor prior to requesting installation. For assistance contact your dean or supervisor.

Purchasing Information (Discipline-Specific Software Only):

Software Purchase Order Number:

Vendor Name:

Please allow 10-15 business days for processing. For an update on the status of your request, contact the ICT Help Desk at (817) 531-4428.