REQUEST FOR ID CARD
Complete the following:
FAMILY NAME ___________________________________ GIVEN NAMES (in full) __________________________________
STUDENT NUMBER _______________________________ DATE OF BIRTH (d/m/yy) ________________________________
PROGRAM (e.g. BA) _____________________ ATTENDANCE/MODE (e.g. part-time/external) _________________________
Read the following carefully 
I certify that I require a card and that I am entitled to a card in order to comply with the statutes and rules so
far as they apply to me as a student of The University of Queensland. I understand that any attempt to
fraudulently obtain an ID card will be dealt with under the University Statutes and Rules and/or referred to
law-enforcement agencies.
Signature of Student
Please enclose a
passport-sized
photo, certified by a
Justice of the Peace
or Commissioner for
Declarations.
Date
STUDENTS MUST PROVIDE THE FOLLOWING EVIDENCE OF IDENTIFICATION
One of the following: Passport or Birth Certificate; or
Two of the following: Drivers' licence, Medicare card, financial institution card, or utility payment.
(Photocopied and certified by a Justice of The Peace or Commissioner for Declarations)
Please supply a return postal address below:
Privacy Statement
The information on this form is collected for the primary purpose of processing your request for a student ID card. The information you provide will
not be disclosed to a third party without your consent unless disclosure is authorised or required by law. For further information, please consult the
UQ Privacy Management Policy at: https://ppl.app.uq.edu.au/content/1.60.02-privacy-management
Please post this form along with a passport size photograph, and evidence of identification to:
UNICARD
PRENTICE CENTRE
GROUND FLOOR PRENTICE BUILDING
UNIVERSITY OF QUEENSLAND
QLD 4072
January 2015