SECURITY CODE REQUEST
Florida Institute of Technology
■
Oce of Security
■
150 W. University Blvd., Melbourne, FL 32901-6975
■
321-674-8112
20200188
This form is to be completed in its entirety and sent to the Office of Security, David Cash, dcash@fit.edu.
Please ensure that the head of your department has signed this form authorizing you to obtain a security code. Failure to have it properly signed will result in a delay in
obtaining the security code you are requesting.
Applicant is solely responsible for his or her security code.
Date ___________________________________
Name _________________________________________________________________ ________ ____________________________________________________________________
First MI Last
Student/employee number _____________________________________________________________________________________________________________________________
If student, when do you plan to graduate? _________________________________________________________________________________________________________________
Contact telephone number ______________________________________________________________________________________________________________________________
Department (what area(s) are you seeking a code to?) _____________________________________________________________________________________________________
Supervisor's name _____________________________________________________________________________________________________________________________________
Supervisor's telephone number __________________________________________________________________________________________________________________________
Supervisor's signature __________________________________________________________________________________________ Date __________________________________
SECURITY USE ONLY
Date request received _______________________________________________________ Date code requested ________________________________________________________
Date code obtained ____________________________________________________________________________________________________________________________________
Date sent to individual ____________________________________ By whom ____________________________________________________________________________________
Date code deleted ________________________________________ By whom ____________________________________________________________________________________
click to sign
signature
click to edit
![]()
