This form should only be filled out by the person requesting the badge

Your Information:

First Name *

Last Name *

Email Address *

No placeholder photos will be accepted, if you do not send a new and current photo your request will be on hold until one is received. *

I understand

** If you are submitting a request due to a name change you must first submit the change through central office**

Status of old Badge: *

What is your previous name? *

Photo requirements :

**Think passport or license ID photo**

- A current photo is required for EVERY badge request

- Color photo (No filters)
- Well lit
- Forward facing and unobstructed (no hats/sunglasses)

- Face clearly visible and in the center of the photo (NOT cut off)
- Solid color background

- Large enough to be clearly visible once printed

- Please no photos of a printed picture

(If you need to use a printed photo it should be scanned)

School(s) you need access to: *

ID Photo : * 🛈

What is your primary position/title? *

Other : Please explain *

Where should we send the completed badge: *

Do you need a badge reel/clip? *

Yes

No

Special Concerns : (ex, special hours or days of the week)

What is your favorite color?