Computer Service Form mm dd yy hh

: mm
FOR OFFICE USE ONLY

Receipt #

HEAT Ticket
Data Center Services & Help Desk PL 022 * 5500 University Parkway * San Bernardino CA, 92407
Phone : (909) 537-7677 * Fax: (909) 537-7215 * Website: http://helpweb.csusb.edu/ Received By

Customer Information Student Faculty Staff Alumni

Coyote ID
First Name MI Last Name

E-mail
Housing Building Name Room Number Phone Number E.g (909) 537-7677 Please Enter your CSUSB email

Equipment Information

Computer Brand Color Serial or TAG #

Model Operating System Password

Please list any additional items that you are going to leave with us:

Problem Description

Services Required :
Wireless Configuration Ethernet Configuration
Malicious Software Removal " Spyware, Adware, Viruses" STOP SIGN
Antivirus Installation Note: Any other antivirus will be removed prior to installing the new antivirus application.
Update my own Antivirus. Note: If the antivirus licence is expired; it will be removed and a new antivirus will be installed.

Waiver of Liability
Department of Risk Management

I, , hereby authorize the Data Center & Helpdesk Services to configure my computer equipment to comply with all
of the security requirements deemed necessary for on-campus network access. DCHS will require at least five (5) business days to complete any computer work.
PLEASE NOTE: I acknowledge and agree that the CSU system and CSU San Bernardino are not at any time responsible for any loss, alteration, or corruption of
any software/hardware, data, or files. DCHS will make every effort to maintain the PC settings as they are. In addition, I acknowledge and agree that it is my
responsibility to back up all software and data that is stored on my computer or peripherals. I give full permission to DCHS to diagnose and configure my
computer and /or perform any other task in order to comply with the minimum requirements set forth by the ISO policy for access to the CSUSB campus
network. For further information please visit: http://www.iso.csusb.edu/policies
Every Windows ™ computer system that connects to the Internet through the CSUSB campus network needs to have an up-to-date antivirus software and
the latest critical updates and security patches installed. DCHS will check and certify that your computer fulfills the above requirements.
I certify that the information provided on this form is correct. I also understand that if my system is vulnerable and infected, Internet access from my computer
will be blocked until proper installations are made and certified by a University Official
NO ONE can request or pick up your computer for you without the following:
a) written authorization from you with a copy of your student ID,
b) his/her valid photo ID and your written authorization as noted in item "a".
I agree to these terms
Signature

By signing this document, I hereby verify that I have read and understood
the conditions and restrictions of this Computer Service Form.
Terms and Conditions:
These services will be provided only to actively enrolled California State University, San Bernardino students, for their personal computers. This service is
only for the removal, installation, modification, or configuration of software. It is not for the removal, installation or modification of hardware.

If the student wishes to obtain this service, a fee of $30.00 USD will be charged. The fee will be paid at the Bursar's office and the student will return to
DCHS with the receipt. This fee will cover that specific computer and will be valid for the quarter in which it is paid regardless of the time that has already
elapsed within that particular quarter. A quarter begins on the first day of class and ends on the day before the following academic quarter begins. This
constitutes the warranty period.

This service is for a computer health diagnosis (software) of a specific computer and an effort to configure that specific PC to meet CSUSB standards. If
the DCHS technicians are unable to configure that computer, the fee charged will not be refunded and the owner is expected to pickup their
computer.

DCHS staff will attempt to make the necessary installation, removal, modification, and/or configuration to the student computer so as to reach the CSUSB
standard as best can be achieved pursuant to the functional and technical limitations of the student's workstation. If after the academic quarter has
elapsed, DCHS still has in its possession a particular computer and the computer is eventually returned to the student and the student claims that the
problem was not resolved, DCHS management will determine, on a case by case basis, whether the workstation will be accepted back under the former
warranty.

A computer will be identified by its serial number or service tag; if a computer does not have a serial number or service tag, that computer may not
qualify for this service. The decision to service a computer or serve a student is reserved for DCHS management.

For all software that a student wishes to have installed on their computer, that student has to provide a valid license for that software. Within the
procedures of DCHS, there is an attempt to complete this service within a specified time frame; however DCHS reserves the right to take as much time as
may be required to complete the service. If the student does not wish to leave their computer(s) for that time, they may pick it up during normal business
hours.

Student Client's Responsibilities

Students receiving this service will:

Pay the required $ 40.00 USD fee at the Bursar's Office for each of the computers they wish DCHS to diagnose and attempt to configure.
Account: Computer Software Services IRT & DCHS (Item Code # 530)

Students will provide DCHS with the following:

a) A current receipt for the computer they wish to have diagnosed and possibly configured.

b) The computer the student wishes to have diagnosed and possibly configured.

c) An electrical power cord and power supply (if appropriate) for the computer they wish to have diagnosed and possibly configured.

d) If software is to be installed, provide the media & licensed software that is required. Configuration of this software may not be performed if too

complex for the technician (For example: Database, Server Applications, etc).

Pick up Information To be signed when picked up

Signature Please Stamp the date

TECH Journal & Notes: Disclaimer to Leave Desktop Computer (NOT Laptop)
while Receipt is obtained

I, ,hereby give DCHS the permission to dispose

of my computer equipment after three days of not returning with a valid
receipt, so that software diagnosis/technical support can begin on my
computer equipment. I understand that this disclaimer is so that DCHS will
allow me the opportunity to go to the CSUSB Bursars Office to pay the
Student Computer Diagnosis Fee ( Item Code #530) and return with a valid
receipt, while I leave my desktop Computer in PL022 Tech-room.

System Completed By
Signature Date/ Time Received By