{"id":509,"date":"2020-05-21T18:52:52","date_gmt":"2020-05-21T18:52:52","guid":{"rendered":"https:\/\/www.wcsu.edu\/westconnect\/?page_id=509"},"modified":"2025-04-07T19:26:41","modified_gmt":"2025-04-07T19:26:41","slug":"card-replacement-form","status":"publish","type":"page","link":"https:\/\/www.wcsu.edu\/westconnect\/card-replacement-form\/","title":{"rendered":"WESTCONNect Card Replacement Form"},"content":{"rendered":"<style>.wForm form{text-align: left;}<\/style><!-- FORM: HEAD SECTION -->\n    <meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\n    <meta name=\"referrer\" content=\"no-referrer-when-downgrade\">\n    <!-- THIS SCRIPT NEEDS TO BE LOADED FIRST BEFORE wforms.js -->\n    <script type=\"text\/javascript\" data-for=\"FA__DOMContentLoadedEventDispatch\" src=\"https:\/\/westconn.tfaforms.net\/js\/FA__DOMContentLoadedEventDispatcher.js\" defer><\/script>\n                    <style>\n                    .captcha {\n                        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href=\"https:\/\/westconn.tfaforms.net\/dist\/form-builder\/5.0.0\/wforms-jsonly.css?v=f9fd65d070a5de368394fbef7eea0e4a09ce19b7\" rel=\"alternate stylesheet\" title=\"This stylesheet activated by javascript\" type=\"text\/css\" \/>\n    <script type=\"text\/javascript\" src=\"https:\/\/westconn.tfaforms.net\/wForms\/3.11\/js\/wforms.js?v=f9fd65d070a5de368394fbef7eea0e4a09ce19b7\"><\/script>\n    <script type=\"text\/javascript\">\n        if(wFORMS.behaviors.prefill) wFORMS.behaviors.prefill.skip = true;\n    <\/script>\n    <script type=\"text\/javascript\" src=\"https:\/\/westconn.tfaforms.net\/wForms\/3.11\/js\/localization-en_US.js?v=f9fd65d070a5de368394fbef7eea0e4a09ce19b7\"><\/script>\n\n<!-- FORM: BODY SECTION -->\n<div class=\"wFormContainer\" >\n    <div class=\"wFormHeader\"><\/div>\n    <style type=\"text\/css\">\n                #tfa_40-L,\n                label[id^=\"tfa_40[\"] {\n                    width: 592px !important;\n                    min-width: 0px;\n                }\n            \n                #tfa_25-L,\n                label[id^=\"tfa_25[\"] {\n                    width: 597px !important;\n                    min-width: 0px;\n                }\n            \n                #tfa_23,\n                *[id^=\"tfa_23[\"] {\n                    width: 331px !important;\n                }\n                #tfa_23-D,\n                *[id^=\"tfa_23[\"][class~=\"field-container-D\"] {\n                    width: auto !important;\n                }\n            <\/style><div class=\"\"><div class=\"wForm\" id=\"203-WRPR\" data-language=\"en_US\" dir=\"ltr\">\n<div class=\"codesection\" id=\"code-203\"><\/div>\n<h3 class=\"wFormTitle\" data-testid=\"form-title\" id=\"203-T\">WESTCONNect Card Replacement Form<\/h3>\n<form method=\"post\" action=\"https:\/\/westconn.tfaforms.net\/api_v2\/rest\/workflow\/processor\" class=\"hintsBelow labelsAbove\" id=\"203\">\n<div class=\"htmlSection\" id=\"tfa_13\"><div class=\"htmlContent\" id=\"tfa_13-HTML\"><div style=\"overflow:hidden;\"><span data-placeholder=\"Please fill in description\" class=\"RichTextView__text___mbcOP RichTextView__editable___IjfQ8 color_classes__color-foreground-1-primary___gUzFc Text__xxLarge___gGM1S\"><strong><span style=\"font-size:11.0pt\"><span style=\"color:red\">There is a $20 charge to replace your university identification card.&nbsp;<\/span><\/span><\/strong><\/span>Once the card is replaced, the replacement fee is not refundable and any previous cards, if found, cannot be reactivated. <u>The fee is charged to your university account, and is payable on-line or at the Cashier\u2019s Office.<\/u> This new card replaces any cards that are lost or stolen and cards that have been damaged from improper care. <br><br>Please refer to the website at <b><a href=\"https:\/\/wcsu.edu\/westconnect\" target=\"_blank\">https:\/\/wcsu.edu\/westconnect<\/a><\/b> for all WestConnect Card policies.<br><\/div><\/div><\/div>\n<fieldset id=\"tfa_43\" class=\"section\">\n<div class=\"htmlSection\" id=\"tfa_49\"><div class=\"htmlContent\" id=\"tfa_49-HTML\"><b>Reason(s) for submitting this form:<br><br>If you are submitting for one of the following reasons <\/b><span style=\"color: rgb(255, 0, 0);\"> - STOP!<\/span><br><ul><li><b>Card Not Working<\/b> - bring card to office for evaluation<\/li><li><b>New Student, no previous card issued<\/b> - submit your photo and instructions on obtaining the card will be provided<\/li><\/ul><\/div><\/div>\n<div class=\"oneField field-container-D    \" id=\"tfa_45-D\" role=\"radiogroup\" aria-labelledby=\"tfa_45-L\" data-tfa-labelledby=\"-L tfa_45-L\">\n<label id=\"tfa_45-L\" class=\"label preField reqMark\" data-tfa-check-label-for=\"tfa_45\"><b>Otherwise, check one of the following:<\/b><\/label><br><div class=\"inputWrapper\"><span id=\"tfa_45\" class=\"choices vertical required\"><span class=\"oneChoice\"><input type=\"radio\" value=\"tfa_46\" class=\"\" id=\"tfa_46\" name=\"tfa_45\" aria-required=\"true\" aria-labelledby=\"tfa_46-L\" data-tfa-labelledby=\"tfa_45-L tfa_46-L\" data-tfa-parent-id=\"tfa_45\"><label class=\"label postField\" id=\"tfa_46-L\" for=\"tfa_46\"><span class=\"input-radio-faux\"><\/span>Lost<\/label><\/span><span class=\"oneChoice\"><input type=\"radio\" value=\"tfa_47\" class=\"\" id=\"tfa_47\" name=\"tfa_45\" aria-required=\"true\" aria-labelledby=\"tfa_47-L\" data-tfa-labelledby=\"tfa_45-L tfa_47-L\" data-tfa-parent-id=\"tfa_45\"><label class=\"label postField\" id=\"tfa_47-L\" for=\"tfa_47\"><span class=\"input-radio-faux\"><\/span>Stolen<\/label><\/span><span class=\"oneChoice\"><input type=\"radio\" value=\"tfa_48\" class=\"\" id=\"tfa_48\" name=\"tfa_45\" aria-required=\"true\" aria-labelledby=\"tfa_48-L\" data-tfa-labelledby=\"tfa_45-L tfa_48-L\" data-tfa-parent-id=\"tfa_45\"><label class=\"label postField\" id=\"tfa_48-L\" for=\"tfa_48\"><span class=\"input-radio-faux\"><\/span>Damaged<\/label><\/span><\/span><\/div>\n<\/div>\n<\/fieldset>\n<fieldset id=\"tfa_10\" class=\"section\">\n<div class=\"htmlSection\" id=\"tfa_28\"><div class=\"htmlContent\" id=\"tfa_28-HTML\"><h4>Personal Information<\/h4><\/div><\/div>\n<div id=\"tfa_11\" class=\"section inline group\">\n<div class=\"oneField field-container-D    \" id=\"tfa_1-D\">\n<label id=\"tfa_1-L\" class=\"label preField reqMark\" for=\"tfa_1\"><b>Name (Last, First)<\/b><\/label><br><div class=\"inputWrapper\"><input aria-required=\"true\" type=\"text\" id=\"tfa_1\" name=\"tfa_1\" value=\"\" title=\"Name (Last, First)\" class=\"required\"><\/div>\n<\/div>\n<div class=\"oneField field-container-D    \" id=\"tfa_3-D\">\n<label id=\"tfa_3-L\" class=\"label preField reqMark\" for=\"tfa_3\"><b>WCSU Student ID #<\/b><\/label><br><div class=\"inputWrapper\"><input aria-required=\"true\" type=\"text\" id=\"tfa_3\" name=\"tfa_3\" value=\"\" autoformat=\"########\" title=\"WCSU Student ID #\" class=\"required\"><\/div>\n<\/div>\n<\/div>\n<div id=\"tfa_12\" class=\"section inline group\">\n<div class=\"oneField field-container-D    \" id=\"tfa_5-D\">\n<label id=\"tfa_5-L\" class=\"label preField reqMark\" for=\"tfa_5\"><b>WCSU Email<\/b><\/label><br><div class=\"inputWrapper\"><input aria-required=\"true\" type=\"text\" id=\"tfa_5\" name=\"tfa_5\" value=\"\" title=\"WCSU Email\" class=\"validate-email required\"><\/div>\n<\/div>\n<div class=\"oneField field-container-D    \" id=\"tfa_7-D\">\n<label id=\"tfa_7-L\" class=\"label preField reqMark\" for=\"tfa_7\"><b>Cell<\/b><\/label><br><div class=\"inputWrapper\"><input aria-required=\"true\" type=\"text\" id=\"tfa_7\" name=\"tfa_7\" value=\"\" autoformat=\"###-###-####\" title=\"Cell\" class=\"required\"><\/div>\n<\/div>\n<\/div>\n<\/fieldset>\n<fieldset id=\"tfa_37\" class=\"section\">\n<div class=\"oneField field-container-D    \" id=\"tfa_40-D\" role=\"radiogroup\" aria-labelledby=\"tfa_40-L\" data-tfa-labelledby=\"-L tfa_40-L\">\n<label id=\"tfa_40-L\" class=\"label preField reqMark\" data-tfa-check-label-for=\"tfa_40\"><b>Would you like to submit a new photo for the replacement card?<\/b><\/label><br><div class=\"inputWrapper\"><span id=\"tfa_40\" class=\"choices vertical required\"><span class=\"oneChoice\"><input type=\"radio\" value=\"tfa_41\" class=\"\" id=\"tfa_41\" name=\"tfa_40\" aria-required=\"true\" aria-labelledby=\"tfa_41-L\" data-tfa-labelledby=\"tfa_40-L tfa_41-L\" data-tfa-parent-id=\"tfa_40\"><label class=\"label postField\" id=\"tfa_41-L\" for=\"tfa_41\"><span class=\"input-radio-faux\"><\/span>Yes<\/label><\/span><span class=\"oneChoice\"><input type=\"radio\" value=\"tfa_42\" class=\"\" id=\"tfa_42\" name=\"tfa_40\" aria-required=\"true\" aria-labelledby=\"tfa_42-L\" data-tfa-labelledby=\"tfa_40-L tfa_42-L\" data-tfa-parent-id=\"tfa_40\"><label class=\"label postField\" id=\"tfa_42-L\" for=\"tfa_42\"><span class=\"input-radio-faux\"><\/span>No<\/label><\/span><\/span><\/div>\n<\/div>\n<div class=\"htmlSection\" id=\"tfa_39\"><div class=\"htmlContent\" id=\"tfa_39-HTML\"><h4>Photo Submission<\/h4><div><br><\/div><div>You can submit a photo using the photo submission website at: <a target=\"_blank\" href=\"https:\/\/csgold.wcsu.edu\/login\/ldap.php\">WESTCONNect WebCard Center<\/a>. If you do not upload an updated photo, the card will be printed with the current photo.<br><\/div><\/div><\/div>\n<\/fieldset>\n<fieldset id=\"tfa_24\" class=\"section\">\n<div class=\"htmlSection\" id=\"tfa_32\"><div class=\"htmlContent\" id=\"tfa_32-HTML\"><h4>Receiving Your New ID Card<\/h4><\/div><\/div>\n<div class=\"oneField field-container-D    \" id=\"tfa_25-D\" role=\"radiogroup\" aria-labelledby=\"tfa_25-L\" data-tfa-labelledby=\"-L tfa_25-L\">\n<label id=\"tfa_25-L\" class=\"label preField reqMark\" data-tfa-check-label-for=\"tfa_25\"><b>Your card may be picked up at the card office or mailed to you, please indicate your preference. <\/b><\/label><br><div class=\"inputWrapper\"><span id=\"tfa_25\" class=\"choices vertical required\"><span class=\"oneChoice\"><input type=\"radio\" value=\"tfa_26\" class=\"\" id=\"tfa_26\" name=\"tfa_25\" aria-required=\"true\" aria-labelledby=\"tfa_26-L\" data-tfa-labelledby=\"tfa_25-L tfa_26-L\" data-tfa-parent-id=\"tfa_25\"><label class=\"label postField\" id=\"tfa_26-L\" for=\"tfa_26\"><span class=\"input-radio-faux\"><\/span>Pick up<\/label><\/span><span class=\"oneChoice\"><input type=\"radio\" value=\"tfa_27\" class=\"\" id=\"tfa_27\" name=\"tfa_25\" aria-required=\"true\" aria-labelledby=\"tfa_27-L\" data-tfa-labelledby=\"tfa_25-L tfa_27-L\" data-tfa-parent-id=\"tfa_25\"><label class=\"label postField\" id=\"tfa_27-L\" for=\"tfa_27\"><span class=\"input-radio-faux\"><\/span>Mail<\/label><\/span><\/span><\/div>\n<\/div>\n<div class=\"htmlSection\" id=\"tfa_36\"><div class=\"htmlContent\" id=\"tfa_36-HTML\">A replacement fee charge will be added to student accounts when the card is printed.<\/div><\/div>\n<\/fieldset>\n<fieldset id=\"tfa_21\" class=\"section\">\n<div class=\"htmlSection\" id=\"tfa_34\"><div class=\"htmlContent\" id=\"tfa_34-HTML\"><h4>Responsibility Statement<\/h4><\/div><\/div>\n<div class=\"htmlSection\" id=\"tfa_22\"><div class=\"htmlContent\" id=\"tfa_22-HTML\">I understand that fraudulent use, possession, or complicity in the use of a lost or stolen identification card is punishable by administrative sanctions and\/or criminal prosecution under the Connecticut Penal Code. If an identification card is found, I am to return it to the University Police Department. The Connecticut state law provides that persons making false reports to law enforcement officials may be punished by imprisonment for no more than one year, or a fine of $1,000 or both. Any enforcement action taken by the University Police Department based on information on this report will be at the discretion of the university. <br><br><b>With my signature, I certify that the above information is correct and acknowledge that I am responsible for abiding by the WCSU WESTCONNect Office policies related to use of the card. &nbsp;<\/b><br><br><div><b>I understand that my university account will be charged $20.00 for the replacement of a university identification card.<\/b><\/div><div><b>Once the replacement card form is submitted, that replacement fee is not refundable and your missing id card, if found, cannot be reactivated.<br><\/b><\/div><\/div><\/div>\n<div class=\"oneField field-container-D    \" id=\"tfa_23-D\">\n<label id=\"tfa_23-L\" class=\"label preField reqMark\" for=\"tfa_23\"><b>Please type your full name in acknowledgement of the above statement.<\/b><\/label><br><div class=\"inputWrapper\"><input aria-required=\"true\" type=\"text\" id=\"tfa_23\" name=\"tfa_23\" value=\"\" title=\"Please type your full name in acknowledgement of the above statement.\" class=\"required\"><\/div>\n<\/div>\n<\/fieldset>\n<div class=\"actions\" id=\"203-A\" data-contentid=\"submit_button\">\n<div id=\"google-captcha\" style=\"display: none\">\n<br><div class=\"captcha\">\n<div class=\"oneField\">\n<div class=\"g-recaptcha\" id=\"g-recaptcha-render-div\"><\/div>\n<div class=\"g-captcha-error\"><\/div>\n<br>\n<\/div>\n<div class=\"captchaHelp\">reCAPTCHA helps prevent automated form spam.<br>\n<\/div>\n<div id=\"disabled-explanation\" class=\"captchaHelp\" style=\"display: none\">The submit button will be disabled until you complete the CAPTCHA.<\/div>\n<\/div>\n<\/div>\n<input type=\"submit\" data-label=\"Submit\" class=\"primaryAction\" id=\"submit_button\" value=\"Submit\">\n<\/div>\n<div style=\"clear:both\"><\/div>\n<input type=\"hidden\" value=\"633-01e7271b6f25e1c2929950789ce6a40c\" name=\"tfa_dbCounters\" id=\"tfa_dbCounters\" autocomplete=\"off\"><input type=\"hidden\" value=\"203\" name=\"tfa_dbFormId\" id=\"tfa_dbFormId\"><input type=\"hidden\" value=\"\" name=\"tfa_dbResponseId\" id=\"tfa_dbResponseId\"><input type=\"hidden\" value=\"5902ea1d3df924b426d3db3ff6977942\" name=\"tfa_dbControl\" id=\"tfa_dbControl\"><input type=\"hidden\" value=\"\" name=\"tfa_dbWorkflowSessionUuid\" id=\"tfa_dbWorkflowSessionUuid\"><input type=\"hidden\" value=\"1775543678\" name=\"tfa_dbTimeStarted\" id=\"tfa_dbTimeStarted\" autocomplete=\"off\"><input type=\"hidden\" value=\"29\" name=\"tfa_dbVersionId\" id=\"tfa_dbVersionId\"><input type=\"hidden\" value=\"\" name=\"tfa_switchedoff\" id=\"tfa_switchedoff\">\n<\/form>\n<\/div><\/div><div class=\"wFormFooter\"><p class=\"supportInfo\"><a target=\"new\" class=\"contactInfoLink\" href=\"https:\/\/westconn.tfaforms.net\/forms\/help\/203\" data-testid=\"contact-info-link\">Contact Information<\/a><br><\/p><\/div>\n  <p class=\"supportInfo\" >\n      <\/p>\n <\/div>\n\n<script\n    id=\"analytics-collector-script\"\n    type=\"text\/javascript\"\n    src=\"https:\/\/westconn.tfaforms.net\/dist\/analytics\/data-collector.f9f54c12ade21135b7c2.js\"\n    data-customer-id=\"766\"\n    data-endpoint=\"https:\/\/analytics.formassembly.com\/v1\/traces\"\n><\/script>\n\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":198,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-509","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.wcsu.edu\/westconnect\/wp-json\/wp\/v2\/pages\/509","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.wcsu.edu\/westconnect\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.wcsu.edu\/westconnect\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.wcsu.edu\/westconnect\/wp-json\/wp\/v2\/users\/198"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wcsu.edu\/westconnect\/wp-json\/wp\/v2\/comments?post=509"}],"version-history":[{"count":0,"href":"https:\/\/www.wcsu.edu\/westconnect\/wp-json\/wp\/v2\/pages\/509\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.wcsu.edu\/westconnect\/wp-json\/wp\/v2\/media?parent=509"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}