NEW RIVER COMMUNITY AND TECHNICAL COLLEGE
KEY/ACCESS CARD REQUEST FORM
(Print and Submit Completed Original to your Cabinet Level Supervisor or Dean)
Today’s Date: _________________
Key(s) and/or access card(s) requested for:
Full Name: _________________________________ Title: ______________________
Department: ___________________________________________________________
Campus phone ext: ______ and e-mail: ________________________@newriver.edu
Building(s) for which exterior door access is required: ___________________________
Area(s), Room(s) and Building(s) for which access is required: ____________________
______________________________________________________________________
By signature below I agree to abide by New River College Procedure No. 38 and the
following requirements of that procedure:
Securing exterior door when entering or exiting while occupying or leaving the
building;
Ensuring that no unauthorized individual enters the building with them;
Notifying the President’s Cabinet Level Administrator or Dean when entering or
exiting the building during non-work hours.
Duplication of College key(s)/access card(s) is prohibited and will be subject to
disciplinary action up to and including dismissal and criminal procedures.
Returning key(s)/access card(s) to the Campus Maintenance/ Security Office on
or before last day of employment with the College. At no time should
keys/access cards be exchanged between employees or kept by a department.
Lost/stolen/damaged keys/access cards will be reported to the Director of
Facilities and Campus Maintenance/Security Office within 24 hours. Employees
may be held responsible for replacement of keys/access cards and may be
assessed a fee to cover replacement.
Signature of applicant: ___________________________________ Date: __________
Approvals:
Cabinet Level Supervisor: ____________________________ Date: __________
Director of Facilities/ designee: _______________________________ Date:
_________________________________________________________________________________________________________
Internal Office use: Date Key Issued __________ Released By: _______________
Date Key Returned __________ Rec
eived By: ______________
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