Proxy Application for an MSD IT Network Account

Use this on-line form to request an MSD IT network username on behalf of someone else.

Only complete this form if you are applying for a user account on behalf of another person. If you are applying for your own user account please use this form instead.

Please read the information found in Accessing the MSD IT Services network.

If a large number (>10) of accounts are to be created at this time, please contact our Service Desk: ithelp@medsci.ox.ac.uk or ring 80030.

Mandatory fields are marked with a red asterisk

University Card

University Card Number

The seven digit number above the user's University Card bar code

University Status

University Status of the account user (printed under the name on the University Card)

Personal Details of the Account User

At which site is the user most frequently based?

Title

First Name

Last Name

Contact Phone

Please supply a 'phone number for the person who will use the account. This should preferably be a Medical Sciences Division department extension number but an external or mobile phone number may be supplied if preferred. This will enable us to contact the account holder if necessary.

Contact Email

Contact details for the person who will use the account. This MUST be a University email address as our user activation process will only send details to a University email address. If the account user does NOT have a University email address you must enter an alternative here but please explain why in the additional information box below.

University Department

If you selected Other above, please enter the account user's Department here

Research Group

Please indicate if the account user is a member of a specific research group within the Department

Job Title

Is this person an elective student or a Foundation Doctor?

Elective Student

Foundation Doctor

neither

Other relevant information

Please add any other information or requirements relevant to the creation of this account

Proxy Applicant Details

Your full name

Your email address

Your e-mail address. You will also be notified once the new account has been created.

Telephone number

We may need to contact you by phone.

Departmental role

Please indicate your departmental role if completing a proxy application. If you are either an Administrator or HR Officer we will accept that authority to request an appropriate unit affiliation.

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Proxy Application for an MSD IT Network Account

University Card

Personal Details of the Account User

Proxy Applicant Details