This release authorizes the resetting of my Network ID Password. I understand that this
information is confidential and I will be required to show a Photo ID before this
process will be done. Once you complete this form, deliver it to the Records Office in
Room 215, Green Woods Hall or to the Computer Center located in the Founders Hall
Annex. If you are mailing or faxing this form, please include a copy of a photo ID.
Date:___________________ Student ID: @_______________________________
Name (Please Print):____________________________________________________
Address: ______________________________________________________________
Date of Birth:_______________ Social Security #:____________________________
Phone #:__________________ Signature:__________________________________
Office Use Only:
Verified By:____________________ Date Received:_______________
Reset By:_____________________ Date Reset:__________________
Northwestern CT Community College
Mail To: Registrar’s Office, Park Place East, Winsted, CT 06098
Fax To: (860) 738-6413