License Type Role 2026

1. Click ‘Get Form’ to open the Employee Badge Request Form in the editor.
2. Begin by entering your first name, last name, and employee number (E#) in the designated fields.
3. Provide your email address for communication regarding your badge request.
4. In the 'Degree/Credentials' section, select your License Type/Role from the provided options. Choose one that best represents your qualifications, such as RN or MD.
5. Indicate your primary clinical practice site by selecting from the list of available locations.
6. Complete the Payment & Delivery Information section. Confirm if the department will be charged for the badge and specify if it is a replacement badge.
7. Fill in the department account code if applicable, and choose your preferred delivery method.
8. Finally, have your supervisor complete their section by providing their name, title, department, phone number, and signature to approve the request.

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