JEFFLINE Access Request

Please fill in the form below and press the 'Submit Request' button at the bottom of the page.

Last Name:	(Required)
First Name:	(Required)
Middle Initial:
Title:
Gender:	(Required) Male Female
Social Security Number: (Used for account verification. We will contact you for the full number is a new account is required.)	The last 4 digits of my Social Security Number are: I do not have a Social Security Number, but will have one soon. I do not have a Social Security Number and will not be applying for one.
Status:
Affiliation:	(Required)
Department:
Preferred Contact Method:	Telephone Email
Daytime Phone:	(Required, at least 10 digits) Please use this format: 999-999-9999 or 999-999-9999x999)
Email Address:	Please use this format: accountname@xxx.yyy)
TJU ID Badge:	(For TJU badge holders only)
How long have you had your ID?	(It can take up to 10 days for new accounts to appear in the JEFFLINE database)
Notes:
You will be asked for the following information if you forget your password: (required for new accounts)
Date of birth:	(mm/dd/yyyy)
Permanent residential zipcode:	(5 digits) Zipcode Lookup (Non-U.S. visitors please enter your current zipcode)