Please note that the information provided below must match the information on file. (Example: Michael vs Mike for First Name)
YOUR IP ADDRESS IS 3.230.152.133 - THIS IP ADDRESS WILL BE LOGGED |
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| First Name: |
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| Last Name: |
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| Last four digits of Social Security Number: |
(Format: 9999) |
| Date of Birth: |
(Format: mmddyyyy eg. June 4, 1974 entered 06041974) |
| Select the role that best describes you: |
Student
Faculty / Staff
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| How would you like your User ID delivered to you: |
Displayed on the Screen and Emailed
Emailed Only
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