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Atomic Learning Account Request Form

Employee Information

Last Name:
First Name:
Department:
School/Division:
Job Title:
Email:
Confirm Email:
Location:
Phone/Ext:

Atomic Learning Usage Information

Which of the following software topics are you most interested in learning via Atomic Learning? Click all checkboxes that apply:

Adobe Acrobat
Adobe Dreamweaver
Adobe Photoshop
Audacity
Blackboard
MS Access
MS Excel
MS Office
MS Powerpoint
MS Publisher
MS Word
Other (please specify):

Atomic Learning Licensing Agreement

An Atomic Learning License has been purchased on my behalf by Touro College, for a limited term of 90 days from the day it is issued to me. I understand that all content and elements of the Atomic Learning website, including its text, graphics, logos, designs, photographs and tutorials, are protected by United States and international copyright laws. Without the express written consent of Atomic Learning, Inc., none of this website’s content or elements may be reproduced or reused in any manner.

Please initial each statement below:

	I shall not copy, download, store, publish, transmit, transfer, or sell any information or data in the Atomic Learning Library or on its Website.
	I shall only use Atomic Learning in accordance with the “Intellectual Property Rights” and “Terms and Conditions of Use” linked on its Website http://www.atomiclearning.com/highed
	I agree to complete a survey on my experience with Atomic Learning, which will be sent to me during or after my 90-day period of use.
Type your name to sign this form: Date: 5/24/2013 You can expect to receive your Atomic Learning username and password, or be notified if there are no more licenses available, via email, within one week.