CALIFORNIA STATE UNIVERSITY, EAST BAY

KEY / ACCESS REQUEST FORM

Section 1: Identification - Enter information of the individual receiving key(s) / access

Net ID

Last Name

First Name

Date

Department

Department ID

Phone

Identify One:

StaffFacultyStudentOther

Section 2: Requestor Information

Title

Name

Department

Phone

Section 3: Request Type - Enter the type of request

Identify One:

NewReplacement (If checked, complete Section 5)

Section 4: Building Access List Buildings and Rooms access is requested for.

Justification of business needs is also required

Justification:

Building

Room#

Building

Room#

ACCESS CARD ONLY (DO not fill in if requesting physical keys)

Check all that apply:

Mon

Tue

Wed

Thurs

24 Hour Format (05:11).

Start Time

24 Hour format (01:55).

Stop Time

Fri

Sat

Sun

24/7

Faculty, Other Expiration Date

Section 5: Replacement / Missing Key(s) / BayCard: Complete this section for all replacement/Missing(s) / BayCard(s)
For lost key: Notify University Police Department and Locksmith Immediately (Lost key requires a University Police report)

Last Date of Possession

Details

UPD Reference#

Name

Section 6: Students Only - Complete this section for student key / access credential requests

Reason

Sponsoring Department

Expiration Date

Department Email

If key is not returned, sponsoring department will be charged $200.00 minimum

Section 7: Required Approvals

Name of Department Dean / Chair / Manager

Email of Department Dean / Chair / Manager

Name and Email of Department Dean / Chair / Manager (required)

Name of Building Key Representative (required)

Name of Director, Facilities Operations (required for Grand Master Keys and Building Master Key ONLY)

Additional Notes

Click here to view the Terms and Conditions