NOTE: After obtaining your department chair/director’s signature, please forward the signed form to Facilities
Management. Once the Facilities Management Director has approved your key request, the form will be
forwarded to the locksmith. You will be notified once your key is made. Should you have any questions, please
do not hesitate to contact the Department of Facilities Management at (662) 246-6441.
KEY REQUEST FORM
DATE: _______________
CAMPUS: _____________________ DEPARTMENT: _____________________
BUILDING: ___________________________ OFFICE/ROOM #: ______________
PERSON NEEDING KEY: _______________________________________________
EMAIL/PHONE #: ____________________________________________________
APPROVALS
________________________________ ________________
Department Chair/Director’s Signature Date
_____________________________________ __________________
Director of Facilities Management Signature Date
FOR LOCK SHOP USE ONLY
KEY SERIES #: _______________________ KEY ID# ___________________
_____________________________________ ___________________
LOCKSMITH SIGNATURE DATE
_____________________________________ ___________________
KEY RECEIVED BY DATE
Mississippi Delta Community College does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and
activities. The following person has been designated to handle inquiries regarding the non-discrimination policies: The Associate VP for
Institutional Effectiveness, Boggs-Scroggins Student Services Center, P.O. Box 668, Moorhead, MS 38761, 662-246-6558.
POSTED 11/07/2019
