UNIVERSITY OF WISCONSIN-STOUT
                                         Campus Card Office, Room 160 Merle Price Commons
                                            1110 South Broadway, Menomonie, WI 54751
                                                          (715) 232-2887
          Student                                                                                                                   Faculty/Staff

The Campus Card Office has established a guideline that governs the release of your photo for identification purposes. The guideline stipulates that
student identification photos will only be released to university departments for campus related business which includes, but is not limited to,
production of Stout OneCard identification card, educational purposes such as e-Scholar advisement and class rosters, emergency, public safety, or the
release as otherwise authorized by law.
           Release of photo is hereby granted _________ YES            _________NO         INITIALS _________________

By signing this contract, a non-interest bearing on-campus debit account is established for a registered student or a faculty/staff member. A debit
account is an account of pre-deposited funds accessed by your Stout OneCard. Only one Stout OneCard, per participant, may be valid at any time.
Deposits to this account can be made in amounts of $10.00 or more at designated locations on campus or at Value Transfer Stations on campus in
various dollar amounts. The terms of this agreement commence when an initial deposit is received. On-campus debit plan funds are transferable
($10.00 minimum) between similar accounts only (ex. Baseline to Baseline; Flexline to Flexline). Seller must be present to authorize transaction.

Purchases with these funds are available on campus at dining locations and many non-food locations for products and services. Funds remain active
and usable on campus while a student is actively enrolled or a faculty/staff member is employed.

Upon withdrawal of enrollment or termination of employment, deposits to the account will be prohibited. Funds are available for use until the
cardholder requests to close the account. After six months, any remaining funds are subject to a $15 monthly service fee.

No refunds will be given for cancellation of this contract for registered students and employees except for participants officially withdrawing from the
University or upon termination of employment. These instances will be confirmed prior to processing the refund. Refund requests must be submitted
in writing. Any remaining funds in the account, less a $10.00 processing fee, will be processed based on current preference selected. (Note: log onto to check preference selection and to verify mailing address, if applicable.)

The remaining balance in the participant’s debit account is displayed at the point-of-sale terminal each time the account is accessed. Occasionally the
account balance is not available at a card reader. During these times, the Campus Card Office (during business hours) will provide a balance. The
participant can at any time request a statement detailing their Account activity through the Campus Card Office.

Report a lost or stolen Stout OneCard immediately by logging into clicking on Card Status and following the prompts, or by
stopping at the Campus Card Office. Failure to report your card lost may result in unauthorized purchases. UW-Stout is not responsible for any loss
due to misuse or fraud of an unreported lost card. Upon Stout being notified of a lost card, the on-campus account will then be suspended.

If a participant believes there is a discrepancy with the participant’s on-campus funds, notify the Campus Card Office as soon as possible. Describe
the transaction in question and explain as clearly as possible the discrepancy (include date and location). Indicate the dollar amount of the transaction.
The Campus Card Office will notify the participant with the results of the investigation within 5 business days. Errors will be corrected promptly. If
more time is required, however, the Campus Card Office may take up to 45 days to review the discrepancy. If the additional 45 days is required the
Campus Card Office will credit the participant’s account so that the participant will have use of the account funds during the time it takes to complete
the review. If the Campus Card Office decides that there was no error, the participant will receive an oral/written explanation with 5 business days
after completion of the account review. The participant may ask for documentation used in the review.

The University may change any term or part of this Contract without sending a written notice to the participant. Changes will be posted at the
following website at least 30 days before change is to become effective. The use of the account or Stout OneCard on
or after the effective date of the change means that the participant accepts and agrees to the change. The university may apply any such change to the
outstanding balance of the account on the effective date of the change of terms and to new charges after that date.

I, the undersigned, understand and agree to the above contract terms and conditions:

Name __________________________________________________                                     ID # ____________________________________
(Please print)  Last            First           MI

_______________________________________________________                                     Date ___________________________________

                                                                  For Office Use Only

                                                      PHOTO IDENTIFICATION REQUIRED

The Campus Card Office requires all new Students and Faculty/Staff members to show a government issued photo identification card before a Stout
OneCard can be produced. One of the following types of identification must be presented: US Passport, US Driver’s License, US State or Federal
issued ID, US Military Card, US Coast Guard Merchant Mariner Card or a Foreign Passport.

Type of Identification presented: ______________________________________________________________________________________

Government Issued ID Number: ______________________________________________________________________________________

Place of Issuance (i.e. WI): ______________ Issuance Date (if available): _____________ Expiration Date: _______________________

                                                                                 Verified by :_______________________________________


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