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Northwest Missouri State University


PERT Assistance Request Form

PERT logo
Residents:
Please fill out this form if you need any assistance with any computer-related problems. All fields must be filled out.

Contact Information

*First Name:
*Last Name:
*Residence Hall:
*Room Number:
Phone Number:
*Northwest
Email Address:

(ex: s123456@mail.nwmissouri.edu)

Computer Issue Summary
Please indicate the following in regards to your computer

Type of Computer:
*Operating System:
If other, please specify:

In this box, please describe the computing problem you are experiencing or the computing area you would like more assistance with.

Which of the following ways would you like the PERT to use when responding to your request?

Visit
Phone
Email

What days and times are you available so the PERT may respond?