College E-Card Application

To apply for an AHPL College E-Card, fill out the form below. Once we have verified your information, one of our staff members will send you an email containing details about your new e-card, including the card number.

Please note that the last four digits of your phone number will be set as your PIN to use online services.

AHPL college e-card program is open to both students and faculty.

AHPL College E-Card Application

Name*
First Last
University*
Please Select One*
- Student
- Faculty
Student ID Number*
Proof of Student Status*
Accepted file types: jpg, jpeg, png, pdf, Max. file size: 300 MB.
Student ID card proves that the person listed above attends the university selected above. Accepted file formats include jpeg images and PDFs.
Faculty ID Number*
Proof of Faculty Status*
Accepted file types: jpg, jpeg, png, pdf, Max. file size: 300 MB.
Faculty ID card proves that the person listed above works at the university selected above. Accepted file formats include jpeg images and PDFs.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Phone Type*
- Home
- Cell
Cell Phone Carrier (AT&T/T-Mobile/Verizon/Etc.)*
Email*
Birth Date*
Comments
This field is for validation purposes and should be left unchanged.

College E-Card Application

College E-Card Application

AHPL College E-Card Application

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