Domain Name Registration Form

To reserve a domain name, complete and submit this form. Please review the Internet and Email Domain Name Management Policy - PDF (290 KB) before submitting this form.

DIR will review and respond within five business days of submission.

After receiving authorization for a requested domain name, a state agency may request delegation of that name at any time. To request the delegation of the domain, email the DIR technical team.
Domain Name
Domain Name Requested:  
The requested domain name is an exception to the policy naming convention.
Agency Head/Designee Title:  
Agency Head/Designee First Name:  
Agency Head/Designee Last Name:  
Agency Head/Designee Email Address:  
Date and Timeline
Date/Time of Request:  
Transition Timeline Start Date:  
Transition Timeline End Date:  
Agency Name
Agency Name:  
Agency Name:
Agency Address:  
Agency City:  
Agency State:  
Agency Zip Code:  
Contact First Name:  
Contact Last Name:  
Contact Phone:  
Contact Email: