Request Login - Governor's University Research Initiative

Name

For name, please enter your complete name, for example Mr. John Doe, M.S.

Title (example, Director)

Enter position/title at the University. Example: Director or Assistant to Director Jane Smith, Ph.D.

Choose the University or Institution:
If OTHER, describe how your institution meets the requirement of an "eligible institution" defined under Section 62.161 (2), Subchapter H of the Texas Education Code and as further allowed in Chapter 61 of this Code.

Enter the Address and other information for the contact (the user requesting the login).

Address Line 1

Address Line 2

City

State

Zip Code

Email Address

Phone

Contact Phone is required, and in format 999-999-9999. Add the letter x for an extension, for example 999-999-9999 x1234.

Phone Type

Phone Type is Mobile, Work, etc. and is optional

Alternate Phone (optional)

Alternate Phone is not required. If entered, must be in format 999-999-9999. Add the letter x for an extension, for example 999-999-9999 x1234.

Alternate Phone Type

Phone Type is Mobile, Work, etc. and is optional

Please let us know any comments or questions that you might have

Proposed Username