Social Media Hub

Account Application Form

Department:

Email Address:

Requested Social Networks:

Please Check One:

Pre-existing Account New Account

Accounts existing before September 7, 2011 are being grandfathered in. If registering an existing account, just include the administrators' names, contact information and signature. No changes in platform name or appearance of these accounts are required.

PROPOSED NAME OF ACCOUNT(S): (NOTE: "EINSTEIN" MUST BE INCLUDED IN THE TITLE, FOLLOWED BY DEPARTMENT OR SUBCATEGORY. PLEASE USE "EINSTEIN COLLEGE OF MEDICINE"AND THE SUBCATEGORY IN THE DESCRIPTION. "AECOM" SHOULD NEVER BE USED.)

Administrators: (must be two, one at management level)

Admin 1:		Admin 2:
Name:		Name:
Location:		Location:
Office Phone:		Office Phone:
Cell Phone:		Cell Phone:

Purpose of Account:

PRIOR EXPERIENCE USING SOCIAL MEDIA: (You must have prior personal or organizational social media experience to be considered as a page administrator. Please indicate account names.)