rev: 07/06/15
College of Engineering – Cal Poly Pomona
Student Bronco Card Access Request
The Engineering Neighborhood has a slide-card system to give students access to outside doors and rooms with the Bronco
Card. Access is granted by recommendation of the academic department with approval by the Dean’s Office. Authorizations
may be changed based on college operational needs. Access is only granted to active Cal Poly Pomona students.
Students may not let others in
to buildings or into any room
. Students who need access must have their own Bronco Card
authorized. Records are kept of all card swipes and will be consulted by College of Engineering personnel if damage is done,
items are missing, or rooms are left unsecured.
Building 17 Yard access, if granted, is for loading and unloading only. You may not park in the Yard.
A University
Parking Permit must be displayed at all times so that we can identify your vehicle. Under special circumstances, an
“extended stay” pass may be obtained in the Dean’s Office. Vehicles left without a pass, or with an expired pass, will be
ticketed or towed.
Student Information: _______________________________ _________________ ___________ _____________
Access Needs: Open University Student Check Here _____
*
09-205, 09-253, 09-409, 17-1211, 17-1623, 17-1631, 17-1635, 17-2103, 17-210 7, 17-2654, 17-2660, 17-2670, 17-2676
Name
Contact Phone ID Number Major
quickly as possible,
access is enabled,
email, reply and
Leave completed form with the Faculty Sponsor who will send it to the department office for chair’s signature.
Access is granted as usually within a week.
Re
newal requests should be submitted four w
eeks before the expiration date.
When email will be sent to your Cal Poly Pomona email address. If you have trouble with access after receiving the explain
the difficulty. You may also email engraccess@cpp.edu.
Purpose and plan of action Departments involved
End Date
Required
Room doors requested:
Access Hours – Check one option
Restrictions and Special Requests: (e.g. Safety test required, May not work alone, …)
The privilege of
having card-swipe access to College of Engineering buildings or rooms depends on responsible actions 24/7:
use your Bronco Card for yourself only and do not admit others who do not have card-swipe access
report lost cards immediately – you are responsible for damages and losses until your card is reported lost
shut doors to keep building secure and do not prop doors open or tamper with the lock system
do not use doors marked "emergency exit" except in an emergency
use facilities responsibly and for their intended purpose; always clean up after yourself before
you leave
make sure that all doors are closed and latched when leaving
Negligence in any of these responsibilities will result in the immediate denial of access.
I understand and accept t
his responsibility: ____________________________________________ ___________
I understand and endorse the purpose of the access described:
________________________________ ____________________________________________ ___________
Faculty Sponsor Name (print please) Faculty Sponsor signature Date
I recommend that the access described be given: ____________________________________________ ___________
Department Chair signature Date
Delivery access to Yard?
oN seY
If yes, Car Make ______________________ License Plate _____________
Briefing & Computer Rooms*
Other Rooms
List room numbers:
_______ BH (Business Hours: M-F 8 a.m. - 5 p.m. [M-Th 7 a.m. - 6 p.m. during 4/10 schedule])
_______ IH (Instructional Hours: M-F 6 a.m. - 10 p.m.; Sat 6 a.m. - 8 p.m.; No access on Sun, holidays, intersession break
[nor F and Sat during 4/10 schedule])
_______ EH (Extended Hours: Everyday 6 a.m. - 12 a.m.)
_______ 24/7 (24 hours a day, 7 days a week)
Date
Student signature