Please provide your information in the spaces provided.
Purpose for card information submission*First time registrationChange of information
First Name*
Middle Initial
Last Name*
Student Identification Number / UA ID (if known/available)
AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Armed Forces the Americas Armed Forces Europe Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon
Driver License Number
P.O. Box or Street Address*
City*
Zip Code*
Home Phone
Work Phone
E-mail Address*
The campus you are taking the majority of your classes through (if you are a distance education student).
UAS - JuneauUAS - JuneauUAS - KetchikanUAS - SitkaUAAUAFmultiple / other (explain in comments)
Comments
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