Account Activation Request Form

First Name
Middle Name
Last Name
Department
Email
Phone Phone - ### - ### ####
Activate Account(s) Requested:

If activating one or more student account(s), please provide their PGY year(s) and UPHS email address(es).

ALL RESIDENTS/FELLOWS MUST HAVE A PENNKEY BEFORE THEIR ACCOUNTS WILL BE RE-ACTIVATED.
Account #1:
Type of Account
Name
Email
Student Level (if activating student account)
Account #2:
Type of Account
Name
Email
Student Level (if activating student account)
Account #3:
Type of Account
Name
Email
Student Level (if activating student account)
Account #4:
Type of Account
Name
Email
Student Level (if activating student account)
Account #5:
Type of Account
Name
Email
Student Level (if activating student account)
Account #6:
Type of Account
Name
Email
Student Level (if activating student account)
Account #7:
Type of Account
Name
Email
Student Level (if activating student account)
Account #8:
Type of Account
Name
Email
Student Level (if activating student account)
Account #9:
Type of Account
Name
Email
Student Level (if activating student account)
Account #10:
Type of Account
Name
Email
Student Level (if activating student account)
Please allow 7-10 business days for your request to be reviewed and processed. OEA staff will contact you regarding your request.