Moodle Special User Request Form
Authorized staff use this form to request Moodle accounts for special users. Regular degree-program students must be submitted to the Director of Digital Learning with full biographical information.
Please enter the first/given name for the account requested.
Please enter the last name/family name for the account requested.
Please enter the email address for the account requested.
Please enter the school or of primary affiliation.
GTU > CARe
GTU > CDS
GTU > CIS
GTU > CJS
GTU > CSS
GTU > CTNS
PSR > CGSB
PSR > CLGS
PSR > TEL
Degree or Certificate Program
Please select the degree or certificate program below.
Certificate or Special
Other (requires e-mail to firstname.lastname@example.org)
Is the user Temporary?
Please select the appropriate status (A= Active, T=Temporary)
If temporary, please enter the account end date.
If this request for a temporary user account, please enter the ending date (for example, a student taking a one-week course only).
Please enter the location of the student in city, state format
Your name? (authorized users only)
Please enter your name and contact information if we have any questions regarding this request.
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