PIN REQUEST

I request that the Office of the Registrar at Eastern Illinois University assign to me a PIN for the purpose of accessing the PAWS system on Eastern Illinois University’s website.

While a student at Eastern Illinois University:

Name: _______________________________________________________

United States Citizen? Yes_____ No _____

Illinois resident? Yes _____ No _____

Married _____ Single _____

Social Security Number ___ ___ ___-___ __-___ ___ ___ ___

What PIN do you want (four digits) ___ ___ ___ ___

This form must be completed and signed and faxed to the Office of the Registrar at 217-581-3412 and it must include a copy of your picture identification, such as a copy of your driver’s license or state I.D. card.

______________________________________________________________

SIGNATURE