Distance Education ID and Library Card Application

If you need additional information, contact:
Library Card Contact Sue Phillips suephil@mountainstate.edu 304.929.1534 800.766.6067, x1534	Student ID Contact James McGee jmcgee@mountainstate.edu 304.929.1351 800.766.6067, x1351

Please take a moment to complete the following form. Carefully review each question.

* = required field

*Student ID Number:
Name:	First: Middle: Last:
*Mailing Address:
*City:
*State:
*Zip:
*Home Phone: (000) 000-0000
*Email:

*Identify your program of study:
*Location of study:
Cohort number (if applicable):
Check here if you would like a student id in addition to a barcode. Checking this option requires you to email studentids@mountainstate.edu a jpeg image of yourself so that it can be placed on the Student ID. If you have questions please contact James McGee at 1.800.766.6067 ext 1351.