Server Donation Program

REQUEST FOR BROADCOM SERVERS

1. Sponsoring department or UCB group: *

2. Requester name: *

3. Requester email address: *

4. Requester phone number: *

5. Purpose type: *

6. # of 64-bit servers requested: *

(maximum for Data Center colocation service or local use: 15)

7. Describe the purpose for this equipment: *

8. Local Use Requesters Only - Describe how racks/peripherals/power cooling will be provided:

9. Address where equipment will be housed: *

10. Delivery option: *

Pick up (free)

Campus delivery ($45)

11. Campus Delivery address:

If "campus delivery" was selected in question #10, enter the campus delivery address here.

The person listed above

is affiliated with the UCB department or group specified, and agrees to take responsibility for compliance with all University and Campus regulations and policies, including but not limited to the UCB Departmental Security Contact Policy (https://security.berkeley.edu/contacts.html); and
agrees to the above conditions

12. Agreement: *

Type yes if you agree to campus policies governing server security and use.

If you have questions about the Broadcom donation or the proposal process, contact broadcom-questions@lists.berkeley.edu for assistance.