Wired Network Connection Request Fill out this form to install a jack for voice, data or cable television services or to activate an existing jack. For help requesting service or using this form, call 486-4357. Impact of Federal and State Asbestos RegulationsDepartment and Billing InformationUCONN Campus*StorrsAvery PointHartfordLaw SchoolStamfordTorringtonWaterburyOtherDepartment Name* Department Number One-Time KFS Account* Department Head's Name Has the department head authorized this request?* Yes No Approval is required. By indicating "yes", your department agrees to pay for all charges that pertain to this request.Contact & Location InformationContact's Name* First Last Contact's Telephone #*Contact's E-mail* Location Information*BuildingRoom# of Jacks Click the plus sign at the end of the row for additional rooms Information provided is used for initial planning, final jacks counts are reviewed and verified after site visitsComments:EmailThis field is for validation purposes and should be left unchanged.