Access Request Form

Indicates required field
Card requested:
Please Note: Religious Affairs
This form is used for individuals working with the Student Life department for an outside company/foundation providing a service.

System set expiration date is preset to June 30th, or sooner if requested below.

For all Renewals- you must submit this form for each individual at least 3 weeks prior to expiration date to avoid any interruption to ID status.

There is no building access on this ID Card. The Department Requestor must contact Public Safety to request any building access.

The department must contact the Help Desk for information about how to obtain an RCS account, if needed.
Please Note: Campus Suppliers
This form must be filled out by the RPI community member, not the supplier. This form is used for all suppliers performing a service for Rensselaer. This form is also to be used for all Rensselaer Tenants.

System set expiration date is preset to June 30th, or sooner if requested below.

For all Renewals- you must submit this form for each individual at least 3 weeks prior to expiration date to avoid any interruption to ID status.

There is no building access on this ID Card. The Department Requestor must contact Public Safety to request any building access.

The department must contact the Help Desk for information about how to obtain an RCS account, if needed.
Please Note: General Campus Visitors

Departmental Guidelines:

  • You cannot submit this form earlier than the Appointment Start date on the Invitation Letter.
  • All International Visitors must be processed by the ISS Office before submitting this request form. They will issue a RIN for the Visitor.
  • All B1 Visitors require Export Control approval.
  • Expiration Date needs to match the Invitation Letter and cannot be more than 2 years (system set limitation).
  • For HS Research Scholars or Special Programs, system set Expiration Date is set to 1 year OR June 30th, whichever is later.
  • Access Renewals must be completed on or before the date of expiration by the RPI Department Member who requests the ID card for the visitor. 

There is no building access on this ID Card. The Department Requestor must contact Public Safety to request any building access.

The department must contact the DOTCIO Help Desk for information about how to obtain an RCS account, if needed.

Please Note: ROTC Faculty and Staff

This form is to be used for any of the following:

  • ROTC Commander – individual commander assigned to an ROTC department (Army, Naval Science, Air Force).
  • Faculty – given clinical faculty appointment through the Office of the Provost but remain on the military payroll. This group receives a 66 RIN for access to student records.
  • Staff Acting Advisor – “BRAVO” advisor – assists cadets and is authorized for a 66 RIN.
  • Staff – military employees to support the ROTC program and remains on the military payroll.

There is no building access on this ID Card. The Department Requestor must contact Public Safety to request any building access.

The department must contact the Help Desk for information about how to obtain an RCS account, if needed.

Your first name:
Your last name:
Your phone number:
Please format phone number as 123-456-7890
Your e-mail address:
Your department name:
Is this a card request renewal?
Type of supplier:
Off Campus: Companies that have individual(s) employed that are performing a service for Rensselaer but these individual(s) do NOT have an office on Campus.

On Campus: Individuals working for an outside company doing a service for Rensselaer with an office ON Campus.

Tenant: A company with a lease/facility use agreement in a Rensselaer managed property (building/space).

Department Vendor: Individuals working as sole Independent Consultants that are providing a service for a specific Rensselaer department and they are not an employee of Rensselaer.
Company or department name:
Company or department requestor:
Company representative:
If applicable.
Date agreement started:
Cannot be more than 3 days from the current date.
Date agreement will end:
Cannot be later than June 30th.
Affiliation:
Start date:
Cannot be more than 3 days from the current date.
End date:
Cannot be later than June 30th.
ROTC Commander:
Applicant's ROTC division:
Category:
Start date:
Cannot be more than 3 days from the current date.
End date:
Cannot be later than June 30th.
Status:
Must match invitation letter.
International Office Designee/Approver:
Applicant's Supervisor first name:
Applicant's Supervisor last name:
Applicant's affiliated department name:
Department requestor:
Program name:
Applicant start date:
Start and End dates MUST match the Invitation letter. Start date cannot be a future date.
Applicant end date:
Start and End dates MUST match the Invitation letter.
Applicant's legal first name:
Applicant's legal last name:
Applicant Date of Birth:
Director-level approval is required for on-campus, off-campus, and department vendors. Approval from an authorized VP, AVP, Provost, Dean, EMPAC, or Biotech Director is needed for all other visitors.
Please upload a JPG image of a photo to be used on your ID card
Maximum file size is 2MB; please decrease image quality if it is too large. Submit a color photo, no hats or dark lenses, filters or watermarks, and must be forward facing against a white or neutral background.
One file only.
Allowed types: gif jpg png.
2 MB limit per file. The accumulated size of all files in this form cannot exceed 25 MB.
Applicant's RIN:
(IF applicable)
Leave this field blank
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