Key Request Form

Dept Acct #

Campus/Department

Position Title

Office Phone

Please issue above employee key(s) to the following areas (include precise building, room numbers):

Name of Department Head

Departmental Access Key Controller

Request Date

Issuance of Keys:

I acknowledge receipt of the key(s) described above. I understand that all keys are property of the College and it is a violation of College policy to duplicate or to have duplicated any key issued by the College. I further acknowledge responsibility and accountability for this key(s). I will report loss or theft of the key(s) to Public Safety & Security immediately and will return key(s) to my department head or Departmental Access Key Controller (DAKC) at time of leaving the department or College. I further agree to remain knowledgeable of and abide by the College’s Access Control policy while in possession of the key(s).

Employee’s Name

Issuing Date

Return of Key(s)

The above key(s) has been returned to the Departmental Access Key Controller.

Name of Key Controller

Return Date

Issuance of Replacement Key(s)

The above key(s) have been lost or stolen. Replacement keys have been issued to the employee.

Name Employee

Name of Key Controller

Replacement Date

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Key Request Form

Issuance of Keys:

Return of Key(s)

Issuance of Replacement Key(s)

Land Acknowledgement

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