UC Quarterly Wage Request Access

Fill out the form below and click Submit to request access.
You also have the option to remove access previously granted to a person.

1. District/Entity (Type "Other" if applicable) *This question is required.

Enter Your Contact Information

2. First Name *This question is required.

3. Last Name *This question is required.

4. Email *This question is required. This question requires a valid email address.

5. Phone Number *This question is required.

6. Are you filling out this form for yourself, someone else, or both? *This question is required.

7. Is the new contact replacing an employee in your organization?

8. Enter the contact information for the person (other than yourself) who needs access.

First Name *This question is required.

Last Name *This question is required.

Title *This question is required.

Email *This question is required. This question requires a valid email address.

Phone Number *This question is required.

8. Additional Contacts

Please enter the name of the person you wish to remove

9. First Name *This question is required.

9. Last Name *This question is required.

9. Is the person being replaced still employed at your organization? *This question is required.

Please check the box below to proceed