University of California, Davis

Student AggieCard
Request Form
University of California, Davis
Office of the University Registrar
One Shields Avenue, 12 Mrak Hall, Davis, CA 95616-8692 | Office: 530-752-3639 | Fax: 530-752-6906
Personal Information
Student ID Number________________________________________________ Email Address _________________________________
Local Address__________________________________________________________________________________________________
City/State/Zip_____________________________________________________ Phone _______________________________________
Academic Level
Graduate School of Management
School of Education
School of Law
School of Medicine
School of Nursing
School of Veterinary Medicine
First AggieCard
Replacement AggieCard
Preferred Name Exchange
I understand the fee for a replacement AggieCard is $15. This fee will be charged to my UC Davis student account. It is my responsibility to pay this fee according to Student Accounting payment schedules.
Student’s Initials (required) ___________
I certify that I am the above named person and the information I have provided is accurate.
Signature___________________________________________________________ Date_________________________________________
Office use only
Currently enrolled
Student charged
Yes; MyInvoice number_________________ No; new student only
`Initial______________ Date_______________
RO Additional Fees Authorization
This revision supercedes all earlier revisions.
rev. 3/14
Student AggieCard Request Form