Fillable CS-K2OLAccessAuthorizationForm - JACKSONVILLE UNIVERSITY facilities access

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CS-K2OLAccessAuthorizationForm - JACKSONVILLE UNIVERSITY facilities access

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JACKSONVILLE UNIVERSITY
CAMPUS SECURITY
REQUEST FOR ACCESS FORM
For Unmonitored usage
Please provide the following information:
Name of Faculty/Administrator making request: ____________________________________
Date: ______________
Building being utilized: _________________________ Room(s): ___________________
Term, or Specific Dates: _____________________________________________________
Time Frame. NOTE: All rooms are closed at 11pm, no access before 8am.: ______________
Authorizer Signature: ________________________ Contact Number: _______________
Note: Entry Authorization Forms cannot be phoned or faxed into Campus Security.
Special Instructions: _______________________________________________________
_______________________________________________________
Approved List of Students Student ID Number
1. ___________________________________________ _________________
2. ___________________________________________ _________________
3. ___________________________________________ _________________
4. ___________________________________________ _________________
5. ___________________________________________ _________________
6. ___________________________________________ _________________
7. ___________________________________________ _________________
8. ___________________________________________ _________________
9. ___________________________________________ _________________
10. ___________________________________________ _________________
Forms are valid until the end of the traditional semester unless otherwise specified. Forms must be
emailed from your employee email. Incomplete forms will be returned to submitter. By typing
your name and emailing this form you are signing the form.
CS-K2OL 01/09
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CS-K2OLAccessAuthorizationForm - JACKSONVILLE UNIVERSITY facilities access

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Completed 6 December 2019

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