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Badge Request Form

Role Selection
Badge Recipient Information
Badge Information
Replacement Badge Information
Please indicate the reason you are requesting a replacement for your SMC ID badge
Name Change Information

Please enter former name in the spaces provided below

Other Details
Please indicate why you are requesting a new badge.
Employee Dept--Title Change Information
Role Details
Indicate primary role at Southwestern Michigan College.
Has the badge recipient ever previously attended or worked at SMC?
Enter former or maiden name badge recipient had while attending Southwestern Michigan College, if different than legal name provided above.
Please enter the name of the badge recipient's business in the space provided above.
Please enter the badge recipient's title in the field provided above.
Employee Spouse Membership Information
Please provide the name of the employee who is the spouse of the applicant.
Housing Resident Information
If the student have been assigned to a room in student housing building, please select the building from the list above or select Not Assigned.
Driver's License or Other Government Issued ID
Emergency Contact Information
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Home Address/Phone Information
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Comments Questions