Facilities Services
BUILDING ACCESS REQUEST FORM
(For key and card access)
Date:
Use the following codes for “Reason” field:
A:
NF:
O:
Lost Key
R:
New Faculty/Staff
Other (please specify):
Returning Keys
NS:
New Student Employee
LR: Lost key/make replacement
LN: Lost key/NO replacement
Use back of sheet for more room.
ROOM/
DOOR
BUILDING
Requested For:
Name
Dept. Authorization:
Facilities Services Rep:
KEY CODE
(or indicate card access
requested)
Contact #
FS OFFICE USE
ONLY
REASON
Date
Dept.
Signature
Date
Signature
Date
Agreement: The keys you hold are property of VCSU, but while you hold them, your responsibility. It is unlawful to duplicate or pass keys
to others persons without official authorization. All keys must be returned upon separation from the University. If keys are not returned,
key holder may face criminal and/or financial charges.
Access Device Received by:
Office Use Only:
Keystone:
Initial
Print Name
Coversheet:
Signature
Initial
Date
File:
Initial
101 College Street SW ♦ Valley City, ND 58072 ♦ 701 845 7705 ♦ fax 701 845 7707
www.vcsu.edu/facilitiesservices ♦ [email protected]