STOCKTON UNIVERSITY
101 VERA KING FARRIS DRIVE
GALLOWAY, NJ 08205-9441
UNIVERSITY AFFILIATE
ENTITLEMENT REQUEST FORM
SECTION 2a
For the following section, refer to the information
provided here as reference.
The Management Entity will select from the choices in Section 2a that represents the division,
department or organization that they are authorized for the approval of University Affiliates.
Section 2a continues on the next page
Administration and Finance (A&F)
Accounts Payable
Procurements & Contracts
Budget & Fiscal Planning
Payroll
Bursar’s Office Procurements & Contracts
Personnel, Labor & Government Relations (PLGR)
Human Resources
Mailroom
Office of Institutional Diversity and Equity
Nation Aviation Research & Technology Park (NARTP)
Pensions & Benefits
Facilities and Operations (FAO)
Department of Facilities Management & Plant Operations
Campus Police Custodial
Department of Facilities Planning & Construction
Stockton Affiliated Services Incorporated (SASI)
Bookstore
Campus Bank
Food Services Transportation Vending
A&F
PLGR
Management Entity / Sponsor Information
Authorizer Name
Authorizer Stockton Phone Number
Authorizer Title
Authorizer Stockton Email Address
SECTION 2
To be completed by Stockton
Management Entity/Sponsor
Applicant Signature ____________________________________________________________________ Date _______________________________________
Authorizer Signature ____________________________________________________________________ Date _______________________________________
Emergency Contact Information
Permanent/Home, Business/Work, Personal Cell, Parent/Gaurdian
For the following section, refer to the
information provided here as reference.
Phone Type:
Sibling, Child, Parent, Doctor, Relative, Spouse, Ex-Spouse, Friend, Gaurdian,
In-Law, Neighbor, Domestic Partner, Significant Other, Advisor/Sponsor, Embassy
Relationship
to Applicant:
Relationship to Applicant
Emergency Contact Last Name Emergency Contact First Name
MI
Apt./Unit # City
County ZIP/Postal Code Country (if not United States)
Emergency Contact Phone Type Emergency Contact Email Address (optional)
Emergency Contact Permanent Street Address
State/Province
Emergency Contact Phone Number
Have you ever been a student or employee of Stockton before?
2. Z-Number
2a. Username
or STK#
2b. What was your
previous role?
Z
Student Prospespective Student (applicant) StaffFaculty
Vendor Contractor
Food Services
Press VolunteerPresenter/Performer
If you have ever been issued a Z or STK number, username or PIN, or vendor ID,
please fill out this section.
Birthdate 1. Ethnicity 1a. (if Caucasian)
Not Hispanic/LatinoHispanic/Latino
Gender
M F
________________
Biographical Information
AA = Black/African American, AI = American Indian/Alaskan Native, AS = Asian,
CA = Caucasian/White, HW = Native Hawaiian or Other Pacific Islander
For the following section, refer to the information
provided here as reference for Question 1.
Ethnicity:
UNIVERSITY AFFILIATE
ENTITLEMENT REQUEST FORM
Last Name
First Name
Prefix
Personal Identification and Information
SECTION 1
To be completed by the
University Affiliate Applicant
MI
Suffix
Apt./Unit # CityStreet Address
County Country (if not United States)State/Province ZIP/Postal Code
Personal Email AddressPrimary Phone Number Primary Phone Type
Primary Vehicle Make Primary Vehicle Model Primary Vehicle Lic. Plate #
S.S.N. (last 4 only)
If Applicant will be parking a vehicle in Stockton
lots/garages, please complete the following fields
