I have read the Plattsburgh State University Information Provider Agreement. I agree to abide by the rules and provisions therein.
Name:_____________________________________________________________ Local Address:____________________________________________________ Telephone (Local):________________________________________________ Telephone (Home):_________________________________________________ Student Username:_________________________________________________
______________________________________________ _____________ Information Provider's Signature Date
Print and send this form to Symen Mulders or Shawn Aguglia, Computing & Media Services, Feinberg Library.