Arizona Western College
Key & Access Code Request Form
Facilities Management and Planning | P.O. Box 929 | Yuma, AZ 85366-0929 | (928) 314-9470 | FAX (928) 314-9529
Date _____________________
Employee ID # ______________________
TO: PRESIDENT OR APPROPRIATE VICE PRESIDENT
Request a key/code be issued to _______________________________________ Position __________________________________
Division/Department __________________________________ Building (one per request) __________________________________________
Supervisor Signature ___________________________________________________________________ Date ________________
Vice President/ Dean / Director Signature___________________________________________________ Date ________________
Vice President for Finance & Administrative Services Signature ________________________________ Date ________________
TO: FACILITIES
This is to certify receipt of key number(s) listed above for the room(s)/building as indicated above. I acknowledge I am held responsible for the
safekeeping and control of said key(s) and will not allow it/them to leave my immediate possession. Key(s) are to be returned to the AWC Police
Department upon my termination of employment and/or during summer vacation. I understand that if I lose a key, I may be charged the
replacement cost. (See Procedure 210.2).
Signature ________________________________________________________________________ Date
Revised 05/18
FT
PT**
REPLACE COMPROMISED KEYCODE
REPLACE LOST/STOLEN KEY(S)
CHANGE OF LOCATION
Room # for key or code
access to be completed
by Supervisor
Corresponding key
to be completed by
Locksmith
_______________
_______________
_______________
_______________
Room # for key or code
access to be completed
by Supervisor
Corresponding key
to be completed by
Locksmith
_______________
_______________
_______________
_______________
_________________
_________________
_________________
_________________
_________________
_________________
_________________
_________________
President Signature _____________________________________________________________________ Date ________________
(President's signature required for Great Grand Master and Grand Master keys only.)
NEW KEY
NEWCODE
When requesting keys or codes, please indicate below "Key" or "Code."
**NOTE: PART TIME EMPLOYEES CAN RECEIVE KEY CODES ONLY
START DATE
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