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Badge Request
Volunteer Request

Badge Holder Request Form

  • Please use this request for users who are not onboarded through HRO
  • All fields marked with asterisk (*) are required.
  • The badge form template can be downloaded here, please fill in the details and get it signed by your supervisor before submitting the request
  • Please enter the form details, upload the picture and completed badge form and click Save.
  • Once you submit the form, Safety will be notified about it.
Personal Information
Email
First Name
MiddleName
Last Name
Preferred Phone
Other Type
Funding Source(s):
Working Status:
Title:
Work Location:

Please select work location

Other Location
Department:
Supervisor Name
Supervisor Email
NYSPI ID Photo

Please review the instructions here before uploading your picture for badge

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Completed Badge Form
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Attestation
Are you submitting on behalf of someone?

Note: Please select the checkbox below to attest when you complete filling the form. Once you certify, your name will be used in place of your signature for this application.

Signature:
Date: