IP-Req

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					                                        K-20 IP Address Assignment Request
                                                        (Revision 2.0 - 03/29/02)

Instructions:
            To fill-in the form, click on the grey fields to mark the checkboxes or to enter information. You may also press the tab
             key to move between fields and use the space bar to toggle the status of the checkboxes.
            Please attach any supporting documentation or diagrams that might offer more details surrounding the Institution's
             network configuration.
            Questions regarding this request form should be directed to regional or district ITU staff or K-20 IP Address
             Administration at ipadmin@wa-k20.net.
            The Washington K-20 IP Assignment Criteria and Requirements Policy will govern K-20 IP address assignment
             requests. Those criteria and requirements are provided as an attachment to this form.
Under Customer Identification, If you are a Library, Baccalaureate, or Community College, the two questions about ESD
Number/Designation and Regional or District ITU’s name do not apply to you. Please leave these blank.
Under Please provide a brief written explanation documenting the nature of this IP request, please provide a description such as,
“XYZ school district requests an additional 50 IP addresses to support the implementation of new Internet-ready PC's at the ABC
elementary school.”
Under Current IP Status, the Border Device is a host that acts as a demark between the K-20 router and the Institution’s network.
This may be a Cisco 2500 series router, a Pix Firewall, a Bay router, or some other type of device. Please specify here what type of
device is being used.
NAT is an acronym for Network Address Translation. Your network’s NAT high water mark is the maximum number of external
connections supported by the NAT device during the reporting period.
Also, please document the Institution’s IP configuration, per the example below, identifying the current and three month growth
projections:
            Please explicitly list all of the Institution’s network IP address ranges, related subnet masks, number of IP addresses used
             within the range, and the three month projected growth in IP address usage.
            Please also list IP address ranges associated with the Institution but are not currently in use.
            Please provide any supporting documentation or diagrams that might offer more details surrounding the Institution's
             network configuration.
XYZ School District’s IP Address Configuration
  IP Address Range            Subnet Mask                        Location                  IP Addresses         3 Month
                                                                                               Used             Growth
10.8.64.0-254          255.255.255.0                 ABC Elementary                             29                 10
10.8.65.0-254          255.255.255.0                 123 Elementary                             28                  4
10.8.66.0-254          255.255.255.0                 DEF Elementary                             27                  0
10.8.67.0-254          255.255.255.0                 456 Elementary                             23                  8
10.8.68.0.254          255.255.255.0                 GHI Elementary                             36                  9
10.8.69.0.254          255.255.255.0                 789 Elementary                             43                  0
10.8.76.63             255.255.255.192               JKL High Business Lab                     100                 25
10.8.77.128-191        255.255.255.192               Unused
10.8.77.0-254          255.255.255.0                 MNO Administration Bldg                     53                0
New                    New                           PQR Elementary (Aug 99)                                      150
Submittal of Information
Please submit this form by email to K-20 IP Address Administration at ipadmin@wa-k20.net.
In addition, if you are a K-12 District ITU and your request is not being submitted by your Regional ITU, you must copy your
Regional ITU when you submit the request.
In the subject of your email please use the following format:
         IP Address Request: <Institution Name>
For example, “IP Address Request: Keller School District.”

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                                        K-20 IP Address Assignment Request
                                                        (Revision 2.0 - 03/29/02)

Customer Identification:

Is this a    School District or ESD, a  Library,                        ESD Number/Designation:
    Baccalaureate, or     Community College?
Institution’s Name:                                                     Regional or District ITU’s name:

Street Address Line 1:                                          Individual Acting as Technical Point of Contact for this Request:
                                                                Name (last, first):     ,
Street Address Line 2:                                          Work Phone:         (    )-       -
                                                                Cell Phone:         (    )-       -
City:                      State:        Zip:                   Pager:              (    )-       -
                                                                E-Mail Address:
Please provide a brief explanation documenting the nature of this IP request.

Domain Name Service:
Please list the hosts you are currently using for Domain Name resolution.
 DNS name:                                                                          IP address:
 DNS name:                                                                          IP address:
Currently WA-K20 does not provide primary DNS services. Please provide the DNS name and IP address for the two authoritative
domain name servers to which primary in-addr service should be delegated.
 DNS name:                                                                 IP address:
 DNS name:                                                                 IP address:
Do you want WA-K20 to provide secondary DNS services?            Yes           No
Current IP Status:
What is your Border Device?                                                Is K-20 your sole Internet Service Provider?    Yes          No
                                                                           If no, please list your other provider(s).

Does the Institution currently utilize NAT?
    Yes      No
If yes, what is your network's NAT high water mark?                        Are you dual or multiply homed?      Yes     No
                                                                           If yes, what is your Autonomous System name?
Please note: If this request is for a site which currently has no routed IP environment in place, please document, in writing or by a
diagram, the current network configuration. Also, please provide host counts for all devices requiring an IP address at present and
project IP address growth in three months. (Please add additional rows if necessary.)
       IP Address Range               Subnet Mask                              Location                    IP Addresses      3 Month
                                                                                                               Used          Growth




Reserved for internal use. Please do not mark below this line.
Received Date:                        Offered Address Space:                               Returned Address Space and Date to Reclaim:

Offered Date:

Accepted Date:




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