Identification Card Request Form

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                                           Identification Card
                                              Request Form
               Human Resources
               Flemming Hall, Stewart-Pollock Wing




     Employee Name: ________________________
     Employee Number: __________
     Department: _____________________________
     Internal Phone Number: ______


     University Identification Cards are produced on Mondays and
     Thursdays each week. Cards are available for pickup the
     following business day. Please be prepared to show identification
     when picking up your new Identification Card. Replacement
     cards carry a $5.00 charge and must be picked up - exact cash would
     be appreciated.

     Please indicate pick up or mail to department:

        Pick Up:                             Mail to Department:


     Signature: ___________________                  Date: _________________

     Please complete, print and sign this form and mail to the address
     below.

                            Staff Card Production
                              Human Resources
                      Fleming Hall, Stewart-Pollock Wing