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Key Request Form Fillable

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4800 East Huron River Drive, Ann Arbor, Michigan 48105-4800 • 734.973.3300 • wccnet.edu
Key Request Form
Do not use this form for fob or prox card requests.
Key Holder Information
Print Name (Last, First M.I.)
Work or Office Phone Number
WCC ID
_________________________
(___) ___-____
@
Job Title
Department
Employment
____________________
_________________
Part-Time
Full-Time
______
Key Request
Justification New Employee Office Move Position Change Lost Key Other:
Key Type
Building
Room #
Description of key or area where access is needed.
Room Key Cabinet/Desk Key Master Key Other
___
___
__________________
Room Key Cabinet/Desk Key Master Key Other
___
___
__________________
Room Key Cabinet/Desk Key Master Key Other
___
___
__________________
Key Requestor Information – The Requestor must be a manager or above.
Print Name (Last, First M.I.)
Work or Office Phone Number
WCC ID
_________________________
(___) ___-____
@
By signing this document I state that the key holder information is accurate. The requestor may not request a key for themselves unless the
requestor is a vice president or above. After signing the authorized signature field, forward this form to the appropriate supervisor for approval.
Authorized Signature
Date (MM/DD/YYYY)
Key Acknowledgement – Key requests must be acknowledged by either a director or above for operating keys or a vice president for master keys .
Print Name (Last, First M.I.)
Work or Office Phone Number
WCC ID
(___) ___-____
@
By signing this document I acknowledge the key assignment as shown above.
Authorized Signature
Date (MM/DD/YYYY)
Forward all requests to the Office of Public Safety, CS 205. It normally takes 5 business days after receipt of the key request form
by Public Safety in order to process and make keys. Keys may be picked up at the Public Safety office in the Parking Structure, Room
205. Please bring a current picture ID. Refer to the WCC Key Procedure at http://facilities.wccnet.edu/wcc-key-forms-procedure for
complete rules and procedures. In the event of a lost key, promptly file a report with the Office of Public Safety, 734-973-3411.
For Public Safety Use Only
Key Code
Copy #
Key Code
Copy #
Key Code
Copy #
Meets Procedure Guidelines
Initials
Request #
Yes No
Employee #
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Completed 8 February 2020

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