Mobile Device Activation Form   

 
--- Approval Process has changed. Please Read! ---
 
Before email activation or use of a mobile device, State policy requires that an up-to-date and signed Mobile Device Agreement Form be on file with your agency management and agency ISO (Information Security Officer).   

When this form is submitted, it will be sent to the email address you provided for the Requester to attach the signed Mobile Device Agreement Form for the user.  Once EITS Helpdesk receives the MDA we will process the request accordingly.

Information of User

First Name:      
Last Name:      
E-Mail Address:      

Information of Requester 
First Name:      
Last Name:      
E-Mail Address:      

  
 
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