Forms

Distance Learner Card & Access Privileges Request

Subject:
First Name:
Middle or Maiden:
Last Name:
Sam ID:
E-mail Address:
Mailing Address:
City:
State:
Zip Code:
Contact Number:
Alt. Number:
 
**I understand that it is my responsibility to report to the Bearkat One Card Office immediately upon the resignation, termination, or change in access status of the above name visitor that I am requesting access for.
 
   

 

Please attach a jpeg photo in order to expedite the request. This must be a government issued ID!

Acceptable forms of Identification

File to upload:

Government Issued ID:

  

Privacy Information

Hours of Operation

Monday - Friday
8:00 a.m. - 5:00 p.m.

Contact Us

Phone: 936.294.CARD (2273)
E-mail: bearkatone@shsu.edu
Location: Estill Building
Suite 230