PSYIT Department of NYSPI- ONLINE REQUEST

Email Request Form:

Please note this: once you submit the form, your supervisor will receive an automatic email asking for a confirmation. Please type in your supervisor's full name and email address correctly. Your request will NOT be processed until your supervisor approves your request.

Upon supervisor's approval, the case will be logged into the PsyIT Help Desk System and your supervisor will receive a case number. To check on the status of your request, please go to HEAT SELF SERVICE.

Items with * are required.

Requested by: (If requested by a third person)
Requestor's email address:
Do you have a Columbia University UNI or NYP account? Yes No Please select one option.
First Name: *
Last Name: *
Title: *
Department: * If Other, please specify:	Other:
Location: *
Work Phone:
Work Fax:
Employed By: *	If you are employed by RFMH DO NOT fill out this form, please contact Dennis Davis at (212) 543-1414. Columbia NY State Please select one option.
Expiration Date:(mm/dd/yy) *
Supervisor's Full Name: *
Supervisor's Email: *