OFFICE OF THE REGISTRAR
MSC 105, 1050 W SANTA GERTRUDIS AVE
KINGSVILLE, TEXAS 78363-8202
PH (361) 593-2811 * FAX (361) 593-2195
www.tamuk.edu
Blue and Gold Connection Password Reset Request
(Complete in Blue or Black Ink)
(MUST INCLUDE A VALID COPY OF YOUR PICTURE ID)
Personal Information:
Name:____________________________________________________________________
First Middle Last
SSN:__________________ K number:_________________ Phone:_
_________________
E-mail: __________________________________ Currently Attending: □ Yes □ No
Student Fa
culty Staff
Signature:_______________________________ D
ate____________________
Picture ID:
On
ce your password has been reset, you will receive a call back or email from the
Registrar’s Office that your request has been processed.
Form can be emailed (PDF attachment) to registrar@tamuk.edu or faxed to (361) 593-2195.
For Office Use Only:
Valid Photo
ID Here
Date Received: _______________________ By: _________________________
Date Processed: _______________________ By: _________________________
Date Notified: _________________________ By: _________________________ Method: Email / Phone
