Get Account Request Form Revised 2172012

Filling out the Account Request Form Revised 2/17/2012 online is a streamlined process designed to help users provide the necessary information for account creation at the Joan C. Edwards School of Medicine at Marshall University. This guide will walk you through each section of the form to ensure you complete it accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Click the ‘Get Form’ button to access the form and open it for editing.
2. Enter your name by filling out the fields for last name, first name, and middle name.
3. Record today's date in the specified format (MM/DD/YYYY).
4. List all previous last names if applicable in the provided field.
5. If you have a Marshall University ID number, enter it in the designated area.
6. Provide your date of birth in the specified format (MM/DD/YYYY).
7. Input your driver’s license information, ensuring you include the state and number.
8. Fill in your mother’s maiden name as requested on the form.
9. Enter your home phone number and daytime phone number in the appropriate fields.
10. Complete the home address section with your street, city, state, and ZIP code.
11. Indicate your user type by selecting the single category that best describes your role with the School of Medicine or University Physicians & Surgeons.
12. Read and agree to abide by all applicable laws and policies, followed by your signature.
13. Date your application in the provided section.
14. Submit the form, ensuring all fields are filled out. You can save your changes, download the form, print it, or share it as needed.

Complete your Account Request Form online today for a seamless experience.