SOM Badge Requests/Access Request

SOM Badge Requests/Access Request

badge access forms will be processed at 401 Quarry, 3rd floor in the Administration Suite.

Name*

How it should read on your badge (including any credentials)

Email:*

Position Title*

Badge Request Type*

Select

Change Needed*

Select

START DATE*

End Date*

Supervisor*

Supervisor's Email Address:*

Access Needed*

SUNet ID#, SID# or Children's Heath ID Number#*

Additional information

If you are requesting access to specific locations inside a building (not the perimeter doors) please provide the reader numbers for the access needed.

File Upload*

New Badges:

1) You must Upload a Front Facing Photo (with single light colored or white background) Please no wildly colorful backgrounds.

Photo Requirements

2) You must upload a photo of a Current Government Issued Photo ID (You will also need to show them this photo ID at the office when you go pick up your badge.

Instructions

Existing Badge: Activating/adding or making a badge change you must:

1) upload a photo of the front and back of your current SOM badge. We need the numbers from the back of the badge to submit the request.

Drag and drop files here or

Lost Badge - Was Security Notified?

If you have not notified Security, you must call 723-7222 and report the badge as lost so they can deactivate it before submitting the new request.

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