Form II.F.1: Request for Designation of Exclusion Zone
Any individual may use this form to request that space within the College be
officially designated as an exclusion zone. This form should be submitted to
the Campus Carry Safety Advisory Committee at CampusCarry@LoneStar.edu
at least 30 business days before the designation is necessary.
____________________________________________ ________________________________
Name of Requester Date
Type of designation requested: Permanent
Temporary
Detailed description of space requested to be designated as an exclusion zone (attach additional
sheets as necessary): _____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Reason(s) why space should be designated as an exclusion zone (attach additional sheets as
necessary): ____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
I understand that any statement I make on this Form II.F.1 which is false, misleading, or not
made in good faith may be grounds for discipline.
____________________________________ ______________________________________ __________________
Printed Name Signature Date
For Office Use Only Date Received: ___________________________________________
Receiving Employee: _____________________________________ ____________________________________
Printed Name Signature
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