AUTHORIZATION FOR PENN STATE id+ CARD FORM INSTRUCTIONS
Name – Enter the last name, first name, and middle initial of the individual receiving the id+ card
PSU ID# - The individual’s PSU ID number must be listed. If a PSU ID number is not already on file for the individual, it is the hiring/sponsoring department’s responsibility to assign a new PSU ID number.
Campus Address – Enter the campus address of the individual receiving the id+ card.
Campus Telephone – Enter the campus telephone number including the area code.
College/Admin – Enter the College/Administrative area.
Select one of 10 appointment types
End Date – Please indicate when the appointment or affiliation with the University is expected to terminate. Cardholder will not be eligible to receive a replacement card beyond this date. Eligibility end dates can be revised and extended by faxing a revised copy of this form to (814)-865-2929.
Signature Line – After the form is completed, the Human Resources (HR) Representative must sign in this location.
Printed Name – Enter the name and title of the HR Representative
Department Name – Enter the Department Name of the HR Representative
Telephone number – Enter the telephone number, including the area code, of the HR Representative
Email – Enter the email address of the HR Representative