Lutheran Theological Seminary at Gettysburg
Student E-mail Application Form

I have read, understand, and agree to the LTSG Information Technology Policies.  I hereby understand the consequences that will result upon my misuse of the computing facilities including the network and electronic mail. The E-mail address you will be assigned is comprised of the first initial followed by the last name followed by "@ltsg.edu". for example, student John Smith would be jsmith@ltsg.edu. In the event your name creates an email address that already exists in the system you will be informed of your correct email address. If printing and mailing this form please return the completed form to Andy Crouse, 61 Seminary Ridge, Gettysburg, PA 17325.

Personal Information
First Name
Last Name

Address


City

State/Province

Zip/Postal Code

Current Email

Phone Number
Degree Program

M.Div | MAMS | MAR STM

Student Year Junior | Middler | Intern | Senior | Other
Estimated Grad. Date
New LTSG Email Account Information
Email Password
Comments

For Office Use Only

E-mail Address:__________________________________________________

Password:______________________________________________________

Date Effective:_________________________ By:_______________________

Date Discontinued:______________________ By:_______________________

Comments:______________________________________________________