Network Engineering and Technology
Vendor VPN Request Form

The Purpose of VPN This form is to be used to request access for consultants to use the VPN connection supplied by Network Engineering and Technology. For staff use F0021, VPN Access for GMU Staff.


Instructions - PLEASE READ - Updated January 7, 2014

Fill out this form online, when the form is submitted you can select to print a copy for your records.. Submitting the completed form will generate a work ticket. All areas with bold italic print and asterisks (*) are required.

If you have any questions, please contact the Support Center at 703-993-8870.

Departmental Information

Sponsor*   Title*
Mason Phone*   Mason Email*

Consultant Information

Company*   Phone*

*VPN Access Requested for (at least first row must be completed):

Name Email Phone Office Location

*Acccess Dates

Start Date:   End Date:

*Reason for VPN Access

*Resources to be accessed. In order to have your request completely in a timely fashion, please include a domain name ( or an IP address and the TCP/UDP ports you will need opened.

This form will print when submitted. it so that a work order can be created.

If necessary, use this button to .


Website Contact:
Net Webmaster
Network Engineering & Technology
George Mason University
Aquia Building, Mailstop 1B5
4400 University Dr.
Fairfax VA, 2030-4444

Phone: (703) 993-9045
Fax: (703) 993-3505

Page Updated: January 7, 2014