USFCard Application: Distance Learning Students

Name: Social Security #:
Address:
City: State: Zip:
Daytime Phone #: E-mail Address:

 Course #

Course Title

Day

 Hours

 Instructor

You will need to include the following items with your completed application:
1. Copy of valid driver's license AND
2. Recent passport photo (minimum 2" x 2") or 3" x 5" photo (facing camera with white background) AND
3. $10 check made out to USF.

Please print and mail your completed form and the additional items to:
USFCard, 4202 East Fowler Avenue, AXA 0094, Tampa, FL 33620

Please read the following information before signing your application:
1. Use of the USFCard by anyone other than the person to whom it was issued is strictly prohibited.
2. The cardholder is subject to disciplinary actions / penalties for improper use of the USFCard.
3. The cardholder is responsible for any and all losses associated with his/her USFCard.

USFCards are the property of the University of South Florida and must be returned upon request. I understand and accept the responsibilities associated with the USFCard and certify the above information is correct.

Signature: --- Date:

Your USFCard will be mailed to the address listed above within five to seven working days. Card numbers are also e-mailed to you when the card is produced. Please contact USFCard Coordinator Delma Rodriguez at (813) 974-2339 with questions.