UNIVERSITY OF PITTSBURGH \ FORM INSTRUCTION GUIDE



FORM TITLE:              UNIVERSITY ID CARD APPLICATION
NUMBER:                  FORM 0015
PROCEDURE:               07-10-01



SIDE 1 - TO BE COMPLETED BY THE APPLICANT

Enter the following information where indicated:

    1.    Social Security Number of Applicant (NNN-NN-NNNN)

    2.    Birth Date (MM/DD/YYYY)

    3.    Name of Applicant (Last, First, Middle Initial - Limit
          to 39 characters)

    4.    Mailing Address Line One (Number and Street - Limit to
          30 characters)

    5.    Mailing Address Line Two (Apartment Number or other, if
          applicable - Limit to 30 characters)

    6.    City (Limit to 20 characters)

    7.    Two letter State Code from DED Table 41

    8.    Zip Code

    9.    Area Code and Telephone Number (AAA-NNN-NNNN)

   10.    Signature of Applicant required

   11.    Date of Application (MM/DD/YYYY)


SIDE 2 -  TO BE COMPLETED BY THE APPROPRIATE ADMINISTRATIVE
OFFICE, ADMINISTRATOR, OR SPONSOR

Enter the following information where indicated:

   12.    Identify individual type in column one, and enter the
          requested information on the corresponding line to the
          right as indicated

   13.    The appropriate Individual Type Code in column two from
          DED Table 18444

Chaplains, Families, Retirees, and Affiliates

   14.    ID Card Expiration Date

   15.    For Family only, indicate relationship of applicant to
          employee, and social security number and name of
          employee

Enrolled and Contract Students

   16.    Admit Term or Session (YY-T)

   17.    For Enrolled Students only, Academic Responsibility
          Center Code from DED Table 18160 and School Major Code
          from SPI 66

   18.    ID Card Expiration Date (MM/DD/YYYY)

   19.    Appropriate Campus Code for regional campus students
          from DED Table 18354

Faculty, Staff, and Emeritus Faculty

   20.    Employment Status Code from DED Table 18232

Faculty Volunteers only:

   21.    Appropriate Expiration Date (MM/DD/YYYY)

   22.    Department Affiliation

Trustees

   23.    Appointment End Date (MM/DD/YYYY)

Approval

   24.    Print Name of Administrator (required)

   25.    Signature of Administrator required

   26.    Campus Telephone Number

   27.    Date (MM/DD/YYYY)