USE YOUR UVA DEPARTMENT LETTERHEAD
ADD DATE
University ID Card Office
PO Box 400313
525 McCormick Road
Observatory Hill Dining Hall Facility
Lower Level
Charlottesville, VA 22903
Dear ID Card Office,
We are requesting a University Academic ID card for a _________________ (type in their
assignment, ie: visiting scholar, part-time/wage, temp, Non-UVA, etc.) in our department. The
REQUIRED information is below:
Full Name (REQUIRED, first middle, last):
Date of Birth (REQUIRED):
UVA Computing ID (REQUIRED):
UVA Oracle Employee ID# (REQUIRED):
Month, Day and Year of Expiration Date (REQUIRED):
Reason for Requesting ID Card (REQUIRED):
Payment Method (REQUIRED, choose ONE reason, remove other):
PTAO# (no grants):
OR Employee to Pay by Cash/Check
If there are any questions, please contact me at: (type in your UVA phone and UVA email)
Sincerely,
UVA SUPERVISOR’S SIGNATURE (REQUIRED)
UVA SUPERVISOR’S NAME
UVA SUPERVISOR/TITLE
09/01/14 aer