Forms, Policy and Procedures Forms for Cardholders BruinCard Terms & Conditions The form required for all first time cardholders to obtain a BruinCard. BruinCard Payroll Deduction Form Due to the UC migration to UCPath, BruinCard payroll deduction sign-up requests,updates, or cancellations are not availableuntil 9/20/18. For more information on the project visit ucpathproject.ucop.edu . Refund Request The form required to request to close your BruinCard debit account and request a refund of any remaining balance. Affidavit of ID Theft and/or Fraudulent Use For use if someone made unauthorized charges to your BruinCard or where a new account was opened in your name. Forms for UCLA Departments Recharge Order Request Use this online submission process for all non-cash award requests and to deposit money to an existing departmental library card (for UCLA Departments use only). Step-by step instructions available here for reference. New Library Copy Card Request The form for UCLA Departments requesting a NEW Copy BruinCard for use at campus libraries to copy and print for business purposes. See Recharge Order Request above for instructions on how to replenish fund on existing copy card. Information Brokers, please use this form here Research Participant Payment Request The form for UCLA Departments requesting to deposit funds on UCLA employee and/or student BruinCards for research participation (human subjects). Affiliate/Guest Request Form The form for UCLA departments to request a BruinCard for eligible visiting guests who are not officially registered students or staff members on the University payroll, but who require a BruinCard for access to services. There must be a 3 months minimum UCLA affiliated status for a card to be issued. Note: The BruinCard Center will be reaching out to campus departments on replacing certain affiliates cards with a new card and number, as ID numbers starting with 009 are being phased out of our system. This is only for affiliates that were issued cards over 1 year ago from 01/01/2014, and are still active. Any recent cards processed within the last year would already have a valid ID number. Meal Cards Form The form for bulk meal card orders. Departments hosting a visiting group can purchase limited-use meal cards to be used for a restricted time. BruinCard Image Request The policy regarding BruinCard image usage. Ask BruinCard to obtain form.
