U.S. Army Corps of Engineers
CEEIS Processing Centers
System User-ID and Password Administration
User ID Application for Non-Corps Users
USER-IDs and passwords are issued for Individual Use Only and may not be shared with others under any circumstances. (AR 380-19) Complete All items on the form, print, sign, and fax to (503) 808-4596. Failure to complete all items will delay processing your request and establishing your User-ID and password. Indicate "N/A" for items that do not apply


Agency
Request Date (DD-MMM-YY)

Office Symbol/Mail Stop
Phone, Commercial (with Area Code)

Name (First, MI, Last)
FAX, Commercial (with Area Code)

E-mail Address

 US Citizen: Yes No

Federal Govt. Employee: Yes No

(Check all that apply) Application for:
CCASS ACASS

Require Communication via Modem: Yes No

Furnish complete mailing address below. (Please use complete zip code, i.e. 99999-9999)

I hereby certify that all of the above information is, to the best of my knowledge, complete and accurate. I understand that the User-ID and password assigned to me is FOR OFFICIAL USE ONLY and I will protect the integrity of my computer access priveleges. Any falsification of the above data or missuse of the system will result in cancellation of my User-ID. I will notify the WPC ISSO of any change in my status as a Government Employee (example: moving to a new location, resignation, etc).


Signature
Date

Do not write below this line


User-ID
Family(s)