Requestor's Information

* Requestor's first name:

* Requestor's last name:

* Requestor's email address:

* Requestor's school/department: Academic Writing Center Center for Latin American Leadership Center for Teaching and Learning Communication and the Arts Divinity Education Global Leadership and Entrepreneurship Government Information Technology Law Library Psychology and Counseling Regent Center for Entrepreneurship Undergrad

New User's Information

* New user's first name:

* New user's last name:

* New user's phone:

* New user's email:

* New user's system role: - Choose - Blackboard User Disted e-Rep

* New user's institution role: Faculty Other Staff

* Does user have a MyRegent account? No  Yes

If yes, what is the username?

* Why does this person need a
Blackboard Account?

Faculty and Students will receive a Blackboard account automatically. Do not use this form to request a faculty or student account.

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