Authorization Code Cancellation Form

Authorization Code Cancellation Form
(If you have any problems with this form, please call Karlyn Jakusz at (715) 346-4716.)

Please use this form if you would like to cancel your telephone authorization code. Your code will be cancelled immediately upon receipt.

First Name:
Last Name:
UWSP ID Number:
Daytime Phone Number: (xxx-xxx-xxxx)
E-mail Address:

Reason for Cancellation:

Withdrawing Graduating Moving Lost/Stolen Other