Revised: January 2006

This form is for use only by Texas Higher Education Network (THEnet) subscribers and the UT System Network (UTSN) members.

The UT System Office of Telecommunication Services (OTS) assigns CIDR IP address blocks to THEnet and UTSN organizations depending on the anticipated number of hosts within each network. The organization's network administrator then assigns specific IP addresses to specific devices (or hosts) out of these blocks. This form must be completed in order to request Internet Protocol (IP) network numbers from OTS.

1. Size of Network Block

Select the IP prefix of the size of the network you are requesting. The IP prefix specifies how many addresses are available in the CIDR block, with lower numbers covering more addresses. See What is an IP Address? for more information.

Please limit your request to fulfill your current need only; you may request more later. A good rule of thumb is that if you do not plan on deploying a network block and assigning addresses from it within the next month, then do not request it at this time.

Size of Network Block (Select the IP Prefix)	/24 (254 hosts, 1 old Class C) /23 (510 hosts, 2 old Class Cs) /22 (1022 hosts, 4 old Class Cs) /21 (2046 hosts, 8 old Class Cs) /20 (4094 hosts, 16 old Class Cs) /19 (8190 hosts, 32 old Class Cs)

2. Justification

OTS requires justification for all IP network block requests regardless of their size. Please indicate how many different sites will be served from the network block you are requesting, how many networks are at each site, and how many hosts there are on each network. Also please describe any subnetting plans you may have which would allow individual IP addresses to be used on more than one network.

Justification for Request

3. Network Name

Choose a name for the network, using no more than 50 characters. It may contain letters, numbers or dashes (-), but no other special characters, such as periods or underscores. This name will appear in the ARIN WHOIS database.

Network Name

4. Technical Contact Information

The technical contact is responsible for resolving technical problems associated with the network and for updating information about the network. The technical contact may also be responsible for hosts attached to this network.

ARIN Handle (if known)
Last Name
First Name
Name of Organization
Address
City
State
Postal Code
Email Address
Telephone Number

5. Geographic Location of Network Site

Identify the geographic location where this network number will be used.

Check this box if the information is the same as the information used for the Technical Contact	(If this box is checked, the rest of this section will be ignored.)

Name of Organization
Address
City
State
Postal Code

6. Requester Information

The requester is the person filling out this form. If you are the Technical Contact listed above, indicate this with the checkbox and leave the rest of this section blank.

Check this box if the requester is the same as Technical Contact	(If this box is checked, the rest of this section will be ignored.)

Last Name
First Name
Email Address
Telephone Number

8. Submit

Click Submit Request to send this request form to OTS.

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