WESTERN KENTUCKY UNIVERSITY ID CENTER

WKU Prox Card Request Form

 

 

**Note: During semester startup times, ATP, and Masterplan, Prox card request processing will be delayed until after the busy period ends.

Previous ID cards must be exchanged before the prox card can be issued. Payment is due upon receipt.

Please list below the individual/s to receive prox (door access) cards:

Last Name:
First Name:

Classification (Student, Staff, etc.)

WKU ID# :
Last Name:
First Name:

Classification (Student, Staff, etc.)

WKU ID# :
Last Name:
First Name:

Classification (Student, Staff, etc.)

WKU ID# :
Last Name:
First Name:

Classification (Student, Staff, etc.)

WKU ID# :
Last Name:
First Name:

Classification (Student, Staff, etc.)

WKU ID# :
Last Name:
First Name:

Classification (Student, Staff, etc.)

WKU ID# :
Last Name:
First Name:

Classification (Student, Staff, etc.)

WKU ID# :
Last Name:
First Name:

Classification (Student, Staff, etc.)

WKU ID# :
Last Name:
First Name:

Classification (Student, Staff, etc.)

WKU ID# :

Last Name:

First Name:

Classification (Student, Staff, etc.)

WKU ID# :

Authorized Preparer:

Last Name:

First Name:

WKU ID# :

Email Address :

Title:

Department/Building:

Extra Notes:

Phone:

Date:

PAYMENT INFO:

Cards/badges are $5.00 each. Full payment must be made upon pickup of cards. Accepted payment methods are Cash/Check, Interaccount form—to be completed by requesting department—must provide both Account Number and Index Number, and Procurement/Debit/Credit Card.

   If you need a copy of this request for your records
                        please print before you click submit button