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New User Form

We will serve to any Rice department or research or service center (with a valid fund). 

Fields marked with a red asterisk must be completed. 

General Information:  
First Name:  
Last Name:  
 * Rice Email Address:  
* Phone Number (___-___-____):   
                     * Net ID:   
* Rice ID Number:  
   * Classification:  
When do you expect to 
leave Rice (month/year)?
   [None] Select a Date Delete the Date
* Department:  
* Advisor/PI Name:  
* Building:   
Room Number (Lab):  
* Chemistry Store Access:  

 Funding Source: 

* Fund Number (i.e. R12345):    Org Number (i.e. 416000): 
Fund Number:                           Org Number: 
Fund Number:                           Org Number: 


Please provide any additional comments about 
how your user account needs to be set-up.