Submit a request – Department of Medicine IT Helpdesk

Please choose your issue below

Your email address

Subject(optional)

DOM ID Number

The 4-5 digit number on the device with a UW-Madison "W" logo. For example, DOM12345

Name of PI

If you are not the PI, please provide the name of the PI you collaborate with

Is internet connectivity needed?

Select answer from drop down

Will this computer need to save data to DOM network shares?

Select answer from drop down

Business reason for extending replacement

Describe the reason(s) the device cannot be replaced at this point in time.

Anticipated extended timeframe (3 months, 6 months, 1-year, etc)

Extended support must have an end date. Computers will be rendered unusable after the extended support end date.

What is your plan to acquire a new system?

The plan should list the major challenges to acquiring a new system as well as how you intend to overcome them by the end date (i.e. budgetary concerns, vendor requirements, work flow changes)

Please give us a brief description

A member of our support staff will respond as soon as possible.

Attachments(optional)

Add file or drop files here