Fill in this form clearly (legible) and completely.

Please reset my Patriot Web PIN to my month, day, and last two digits of my year of birth (MMDDYY).

Full Name: ______________________________________________________

Birth Date: ______________________________________________________

G Number or Social Security Number: _________________________________

Phone number where I can be reached during the day: ___________________

E-mail Address: ___________________________________________________

Signature: ________________________________________________________

Fax this completed form and a copy of your Photo ID (Mason ID, drivers license, or passport) to the ITU Support Center at 703-993-3347.

• Request forms that are incomplete, illegible (unable to read), or for which the proper photo identification is missing will not be processed and will be destroyed.
• Please do not call to confirm if we have received your fax.
• We will try to reset your PIN within one business hour. Please note that during peak times in the business day your request might take more than one hour. Business hours are Monday - Friday 8:00 am - 7:00 pm during fall and spring semesters, and Monday - Friday 8:00 am - 5:00 pm during semester breaks and summer.
• Call the ITU Support Center at 703-993-8870 if you have problems faxing this form.
• Note: Students with a Privacy (confidential) Flag cannot request their PIN reset by fax. Call the Registrar's Office at 703-993-2441 for instructions.