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 credential in My Photo are also required.      

Who Is Filling Out This Request?
Applicant Name
If you provide a Lived/Preferred name, we will print this on your R’Card instead of your legal first name.
Your EIN can be found in your Dashboard on the UCPath website:
Credential Needed?

Map to our location at the Highlander Service Station.

Mailing Address
Campus Address

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