Remote ID Badge Request Form

This form is for non-employees (NEPAR, affiliated students, UMMC students) to request a UMMC identification badge. In order to complete this form you will need the following:

1. Photograph for badge:

   1. Check behind you. The background must be solid (no textured surfaces, bricks, trees, etc.) and neutral in color (white, gray, or off-white only).

   2. You may smile!

   3. It is not necessary to crop the image – we will handle that for you. Just make sure the photographer is standing far enough back that your full-shoulder-width is captured in the photo.

   4. Remove any head coverings that are not religiously or medically indicated.

2. State-Issued Photo Identification (driver’s license, state ID, passport):

   1. It is acceptable to upload an image taken by cellphone.

   2. ID must be valid and un-expired.

   3. ID must contain a photo that can confirm your identity.

3. Fingerprinting/Criminal History Record Check: If you were fingerprinted by UMMC, we can access those records for you. If you were fingerprinted at another Mississippi licensed healthcare entity, you will attach the notarized clearance letter they issued.

Within 5 business days of submitting your form, you will receive an email notification that will either confirm that your badge has been printed or provide feedback and instructions.