University Health Care - University of Utah - Human Resources
University Health Care
Hospitals & Clinics
Non-Staff and Volunteer
Photo ID Authorization Form
Name: _________________________________________
Job Title________________________________________
Organization:____________________________________
Proximity Card required yes no
Non-Staff / Volunteer ID Number:__________________
Vendor charge $20.00 Yes
Sponsoring Dept: _______________________________
Name to be listed on the ID Badge
Sponsor Ext.: ____________
Sponsoring Dept. Representative Printed Name
________________________________________________
Sponsoring Dept. Representative Signature
Date: _______________
Form to be used by: Students, Per Diem/Contract Agency Staff, Vendors, Volunteers and Contractors.
The Hospital U Card Office is located in the Cafeteria on “A” Level. You must have a valid picture ID to obtain your new U Card.
*This form will be retained by The U Card Office
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