Key Request

[Finance and Administrative Services] [Facility Services]

Last Name:

First Name:

Middle Initial:

Campus ID:

Campus Phone #:

Your Email:

Person Authorized to Approve This Key Request for You:

(Don't Use Social Security Number)

Employment Status (choose one)

Position

Department:

CARD ACCESS: (For Key Cards Only)

Start Date:

End Date:

Authorized Hours:

Authorized Days:

LOCATION(S) KEYS ARE TO ACCESS:

Building
	Room:
	Room:
	Room:
	Room:

PROPERTY KEYS ARE TO ACCESS: (Number = CSUSM BARCODE NUMBER)

Property Number
Property Number

Comments (please include if this is a replacement access card):

NOTICE - Read Carefully

All keys issued by this University remain the property of CSUSM and the State of California Keys and Cards are subject to the current approved "KEY ISSUE POLICY & PROCEDURES."

	1. Keys are issued ONLY to end-users.
	2. Keys are not to be duplicated.
	3. Keys are not to be used by or transferred to others.
	4. Fees will be assessed for lost and/or unreturned keys.

I have read and agree to the above stated conditions. I realize that I am to maintain control of all keys and cards issued to me, and that they will remain in my possession until returned to Key Issue.

Agree

Disagree