Check one: Staff Faculty Student
Other:
Check one: New Replacement Other:
Mon Tue Wed Thurs
Fri Sat Sun
Details:
Reason:
Address:
Department
PeopleSoft DEPARTMENT ID
Room #
Room #
Room #
Email
Phone
Email
Name
Department
Building
Signature of Student Sponsor:
Signature of Key / Access Card Holder:
State
City
Zip
Street
The deposit will be refunded by mail when key(s) is / are returned to Facilities Management.
$20.00 Deposit per key must be paid to the University Cashier, and a receipt attached to this request
365
24/7
Last Date of Possession
Room #
Signature of AVP, Facilities Development & Operations (required for Grand Master Keys and Building Master Keys ONLY)
Section 1: Identification - Enter information of the individual receiving key(s) / access credential(s)
ALL FIELDS ARE REQUIRED
University Key/Access Credential Request Form
Section 2: Requestor Information
Section 3: Request Type - Enter the type of request
Section 4: Building Access - List Buildings and Rooms access is requested for
Section 7: Required Approvals
Section 6: Students - Complete this section for student key / access credential requests
Signature of Department Chair/Manager (required)
Last Name
Net ID
Student, Faculty Expiration Date
Signature of Building Key Representative (required)
Questions: Call 5-4444
Submit completed form
to: Facilities
Management University
Key(s) FM
Form Updated Oct. 2016
Date
MI
Room #
First Name
Section 5: Replacement / Missing Key(s) / BayCard: Complete this section for all replacement / missing key(s) / BayCard(s)
Access Credential ONLY Days (Check all that apply):
Start Time
Stop Time
Clear
Print
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
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