Access Request Form

For Faculty/Staff use only. Students should contact their faculty advisor or department staff to request access.

This form is the Access Request Form for Undergraduate, Graduate, Postdoctoral Students, Faculty and Staff. One individual per request; multiple rooms allowed per request. If you need to submit requests for multiple individuals, email those requests to support@eng.ua.edu using this template.

ACCESS REQUESTED BY

First Name *

Last Name *

UA Email Address *

Other Area

ACCESS TO BE ISSUED TO:

First Name *

Last Name *

UA Email Address *

CWID *

Other Area

ACCESS FOR:

Building(s) and Room Number(s) *

(Example: Bevill Exterior, 243 Hardaway)

Other Purpose

Access Expiration Date *

Maximum expiration dates: Students- September 15, 2025 Faculty/staff-five years from request date.

Additional Comment to Approver(s)

As the requester, I verify that the individual receiving the key(s) has been informed and understands the following:

They are fully responsible for the borrowed key(s), and the key(s) may only be used for approved activities associated being issued the key(s).
They must return the key(s) or have the key(s) reissued to them prior to the end of each term or earlier if requested.
A fee of $100/key will be charged to their UA account for failure to return borrowed key(s).
They must report immediately if any borrowed key(s) is(are) lost, stolen, or damaged.
A fee of $100/per key will be charged to their UA account for any lost, stolen, or damaged key(s).
Failure to pay any associated fees may result in non-issuance of grades or their diploma.

As the requester, I understand if any fee associated with an unreturned, lost, stolen, or damaged key is not recovered from the individual, then the fee will be charged to the requesting unit.

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Access Request Form

ACCESS REQUESTED BY

ACCESS TO BE ISSUED TO:

ACCESS FOR:

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