MOSIS Customer Instructional Account Application

After you submit your online application, your account will be enabled only when we receive your signed copy of MOSIS Customer Agreement. The MOSIS Customer Agreement is available online.


School
 School Name:
 Division/Department:
Administrative Point of Contact
The administrative point-of-contact should be a person with primary organizational responsibility for the account, who communicates with MOSIS about issues related to account access passwords, expiration dates, and other account parameters. The Administrative point-of-contact should be the class professor or instructor. A student may not be the primary contact for an account.

 Primary Contact Name: (should not be a student)
 Last Name: First Name: Middle Name:
 Shipping Address: (We will not ship to a post office box.)
 Address line 1:
 Address line 2:
 Address line 3:
 City:  Postal (ZIP) Code:
 U.S. State:  Province/Region:
 Country:
 Phone:  Fax:
 Enter only one E-mail Address
 E-mail:
 Re-enter
 E-mail:
 Password:  Re-enter
 Password:
 Web Site:
Technical Point of Contact (If different)
The technical point-of-contact should be a person who answers the students questions about designs, fabrication issues and how to work with MOSIS. The technical point-of-contact can be the class professor, instructor, technical staff or student lead.

 Secondary Contact Name: (should not be a student)
 Last Name: First Name: Middle Name:
 Phone:  Fax:
 Enter only one E-mail Address
 E-mail:
Fabrication Plan
Technology Date
DD-MON-YYYY
Design sizes (mm)