California State University Dominguez Hills now has the capability of issuing identification cards to School of Nursing students, if you provide a picture. Nursing personnel will scan your photo and Admissions and Records will create a school identification card that can be punched to wear on a lanyard or clip to a pocket*. The badge will be mailed to your home. The BRN requires every registered nurse must be clearly identified with picture identification and title. This identification card should be worn in any clinical settings where students are participating.

Picture
The picture must be 2x2 inches. It can be in color or black and white. The picture must be full face, front view and in normal street attire. Any passport photo can be used for the picture on the identification badge. The photo will not be returned to you. It will be attached to your student file which is kept in the College of Health & Human Services area. Thank you.

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If you would like to utilize this service, please provide the following information. Be sure to include a picture with the form below.

Name: ________________________________________________________
(as it apprears on your school records)

Student ID#: _______________________________________________
(This information will not appear on your id)

Address: ______________________________________________________

City: _________________________ State: _______ Zip: __________

Telephone: ___________________

Days: _______________________________ Eves: __________________________

Email address: ______________________________________

Please return this form to:

Cathy Crandall
School of Nursing – 700
CSU Dominguez Hills
1000 E. Victoria St., Carson, CA 90747

*lanyard or clip not provided