McNEESE STATE UNIVERSITY
REQUEST FOR STUDENT IDENTIFICATION NUMBER
OR BANNER SELF-SERVICE PIN RESET
Please complete and sign this form, then send it by mail or fax to: McNeese State University
Office of the Registrar
Box 92495
Lake Charles, LA 70609
Fax (337) 562-4234
If you have any questions, please call (337) 475-5158 or (8
00) 622-3352 extens
ion 5158.
Check all that apply:
_____
I request that McNeese State University release my Student Identification Number.
_____
I request that McNeese State University reset my Banner Self-Service PIN to my date of
birth in the format mmddyy.
Complete the following:
SSN or Student ID: _________________________________ Date of Birth: ______________________
Full Name:
Last First Middle Maiden
____________________________________________________________________________
Mailing Address: ________________________________________________________________________
Street or P.O. Box City State Zip
Daytime Phone: ______________________ E-Mail Address: __________________________________
Please e-mail response to: ______________________________________________________
Please fax response to: ________
______________________________________________
Please mail response to: ______________________________________________________
_
_
_____________________________________________________
_____________________________________________________
I authorize McNeese State University to release my Student Identification Number and/or reset my PIN to my
date of birth (mmddyy) and to notify me when my request ha
s been completed. I understand that McNeese is
not responsible for the security of information sent by fax, e-mail, or mail.
Signature: ____________________________________________________ Date: _________________
Note: Include a copy of your driver’s license on a separate page.
Revised August 2008
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