/ / Application Form for
New Domain Name
For the prevailing policy on domain name, please visit http://wikisites.cityu.edu.hk/sites/upolicies/dnpolicy
To be completed by requesting department
Department: / Project code
(for Research Projects)
Name: / Telephone (or ext.):
Email: / Date of Request:
New Domain Name: / Date Needed:
Domain Name Holder, Name: / Email:
Administrative Contact, Name: / Email:
Technical Contact, Name: / Email:
Domain name is/will be resolved at: / □ University DNS server / □ External DNS server / IP address:
Node name:
If this domain name or service is to be hosted by an external or internal Service Provider (SP), please supply the following:
Name of the SP: / Server’s Node Name:
Server’s IP address: / Fax:
PO number (if applicable): / SP’s contact -Telephone:
Description of hosted service:
Justification in what the domain name is intended to represent or convey:
To help the University manage better and CSC serve you better, please check all those of the following that apply to the domain name concerned:
□ Denotes a recognized name of a unit/office/ department of the university
□ denotes a university service entirely provided by your unit/office/department only
□ purchased with University fund
□ used by official student organization
□ used by legitimate university business
□ used by people from different organizations inside the university / □ used by people from different organizations outside the university
□ used for part of a CityU outreach program or for serving non-profit organization
□ other justification or relevant information
To be completed by Head of department or Principal Invigilator
Authorized by: / Date:
(Printed name and title)
Signature:

CC180/4

To be completed by CSC
Application is / □ approved / □ disapproved
Comments:
Approved by: / Date:
Handled by: / Date of Action:
Date Notified Dept:
□ New domain name is to be served by central name servers
NS (Domain delegation, i.e., zone.cityu.edu.hk)
A (IP Address):
MX (Mail Routing):
CNAME (Alias):
□ New domain name will not be served by central name servers, verified DNS information as below:
DNS’s Node Name: / DNS’s IP address:
□ Service related to the new domain name will not be served by central, verify server information below:
Server’s Node Name: / Server’s IP address:
Remarks:

Please return the completed form to the General Office of the Computing Services Centre.