Department Request Form for Staff, Faculty and Postdocs

Indicates required field

This is a request only. Only applicants who are active in UC Path with an official start date that has passed will be approved to receive this service. Approval of your photo and identity credentials is also required.

Who Is Filling Out This Request?

Administrator Name

Department Name

Administrator Email

Administrator Phone

Applicant Name

Legal First

Middle

Last

Lived/Preferred Name

If you provide a Lived/Preferred name, we will print this on your R’Card instead of your legal first name.

NET ID

UCR Email

Phone

Employee ID Number

Your EIN can be found in your Dashboard on the UCPath website: ucpath.universityofcalifornia.edu.

Employee Start Date

Status

Building Where Employee Works

Credential Needed?

Select Method of Payment

Entity

Fund

Activity

Account

Function

Program

Project

Flex 1

Flex 2

Select Method of Delivery

Map to our location at the Highlander Service Station.

Mailing Address

First

Last

Mailing Address Line 1

Mailing Address Line 2

City

State

Zip Code

Campus Address

First

Last

Building

Room

Special Instructions for Card Office

Please submit all items (e.g., form, payment, and photo) within 30 days of this request, or your request will be deleted.