Nautilus Card Identity Verification Form Instructions

Nautilus Card Identity Verification Form
Instructions
The Nautilus Card Identity Verfication form and required documents must be submitted
by students who wish to obtain a University of West Florida Nautilus Card and are part of
the 2UWF program must mail their Nautilus Card request. Students must be currently
enrolled in the 2UWF program in order to receive a Nautilus Card.
Instructions:
Step 1:
Complete all fields in Section 1 of the Nautilus Card Identity Verification Form.
Step 2:
Present the Nautilus Card Identity Verfication Form to a licensed Notary Public for
completion of Section 2.
Step 3:
Complete the Nautilus Card Agreement.
Step 4:
Return the following documents to:
University of West Florida
Nautilus Card Office
11000 University Parkway, Bldg. 20W
Pensacola, FL 32514-5750
Completed Nautilus Card Identity Verification Form
Completed Nautilus Card Agreement
Copy of photo identification presented to Notary Public
Color passport photo (Passport Photo may be obtained from WalMart, CVS,
Walgreens, and other retailers. A color copy of your passport is NOT needed.)
Step 5:
Please allow 7 to 10 days for delivery of the Nautilus Card once the form and
required documents have been received by the Nautilus Card Office.
X
Nautilus Card Identity Verification Form
I am requesting a University of West Florida Nautilus Card, and by submitting this form and the other
documents requested, do hereby certify that the information provided is true and accurate.
Please select the location where you are enrolled:
NWFSC
GCSC
Section 1:
PSC
TCC
To be completed by applicant
Print Name: _______________________________________________________________________________
(First Name, Middle Initial, Last Name)
UWF ID#: ____________________________________ Date of Birth: ________________________________
(Contact 2UWF Program Coordinator for UWF ID#)
Email: ________________________________________ Daytime Phone: ______________________________
Mailing Address: ____________________________________________________________________________
City: _________________________________________ State: _____________ Zip Code: ________________
Signature of Applicant: ______________________________________________ Date: ___________________
(Sign in the presence of a Notary Public)
Section 2:
To be completed by Notary Public
State of _______________________________________ County: ____________________________________
I hereby certify that on this __________ day of _______________________________________, 20_________,
_____________________________________________ personally appeared to me the signer and subject of
the above form, who signed or attested to the same in my presence, and presented one of the following forms
of photo identification as proof of his/her identity:
Driver’s License - State Issued: ________________ DL#: _______________________________________
Passport - Passport #: ___________________________________________________________________
Gov’t Issued ID - Type: ____________________________ ID #: _________________________________
Notary Public: __________________________________________
(Print Name)
My Commission Expires: __________________________________
Notary Public Signature: ___________________________________
(Reserved for Notary Seal)
The Nautilus Card is the official University of West Florida Identification Card. This card also serves as a library card, a copy card,
an access card, a debit card and a meal plan card. Proof of identification is required when obtaining a Nautilus Card. Driver’s
License, State/Government issued picture I.D., or Passports are accepted forms of identification.
The information contained in the card system, including your Nautilus Card photo, can be used by the University of West Florida for
internal University business purposes as deemed appropriate and approved by the Vice President of Student Affairs for students and
approved by the University General Counsel for employees.
To make use of the debit card feature of your Nautilus Card, you may deposit money into two different accounts:
Declining Balance Account: Money deposited into this account may be used to make purchases at any location on campus
which is connected to the Nautilus Card system, including Dining Services locations.
Once funds have been deposited into your account, they may only be withdrawn by way of purchases. You may not withdraw cash
prior to your graduation or withdrawal from the University.
If you have money in your Nautilus Card account(s) at the end of the academic term, it will be carried over into the upcoming
academic term’s balance. You may request a refund of any balance remaining in your account when you graduate or withdraw
from the University.
If you fail to request a refund of any balance remaining in your account for a period of six (6) months after you graduate or withdraw
from the University, the balance may be deemed abandoned property, in which case the balance will be remitted to the State of
Florida, or you may choose to contribute any balance in your account to the UWF General Scholarship Fund.
Please indicate how you desire to have treated any balance remaining in your account more than six (6) months after you graduate or
withdraw from the University by checking the appropriate box below:
 Contribute to UWF General Scholarship Fund  Abandoned Property
There is a $10 annual I.D. fee. The fee is charged the first semester on campus and recurs annually thereafter each fall semester. The
fee covers the cost of ongoing services provided by the Nautilus Card program.
If your card is lost or stolen, please contact the Nautilus Card Office (474-3324) immediately. After business hours, you may call
the University Police (474-2415). Card invalidation will be immediate. The University of West Florida is not responsible for cash
balances of lost cards. The charge for a replacement card is $15.
I have read and agree to the above conditions.
__________________________________________________ ________________________________________________
Signature Date
__________________________________________________ ________________________________________________
Name (printed) UWF ID #
Rev. June 2014