Key Request Form – College of Engineering

This form is the Key Request Form for Undergraduate, Graduate, and Postdoctoral Students. One student per request; multiple keys allowed per request.

KEY(S) REQUESTED BY

(Keys can only be requested by CoE Faculty and Staff only)

First Name *

Last Name *

UA Email Address *

As the requester, I verify that the student 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 student, then the fee will be charged to the requesting unit.

KEY(S) TO BE ISSUED TO:

First Name *

Last Name *

UA Email Address *

CWID *

KEY(S) FOR:

Building(s)*:

*Undergraduate students are not issued keys to exterior building doors

Room(s):

Other Purpose

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