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
MI
Date
Department
Department ID
Phone
Email
Identify One:
Staff
Faculty
Student
Other
Section 2
:
Requestor Information
Title
Name
Department
Phone
Email
Section 3
:
Request Type - Enter the type of request
Identify One:
New
Replacement (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
Please select...
All Labs
Art and Education
Boiler Room
Bookstore
Concord Campus
Corporation Yard
Dining Commons
Facilities Management
Field House
Library
Library Annex
Meiklejohn Hall
Music Building
New University Union
Original University Union
Physical Education
Pioneer Heights
Recreation & Wellness Center
Robinson Hall
Science - North & South
Student & Faculty Support
Student Health Center
Student Services & Administration
Theater
University Grounds
Valley Business & Technology
University Grounds
Core Building
Room#
Room#
Room#
Room#
Building
Please select...
All Labs
Art and Education
Boiler Room
Bookstore
Concord Campus
Corporation Yard
Dining Commons
Facilities Management
Field House
Library
Library Annex
Meiklejohn Hall
Music Building
New University Union
Original University Union
Physical Education
Pioneer Heights
Recreation & Wellness Center
Robinson Hall
Science - North & South
Student & Faculty Support
Student Health Center
Student Services & Administration
Theater
University Grounds
Valley Business & Technology
University Grounds
Core Building
Room#
Room#
Room#
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).
x
Start Time
24 Hour format (01:55).
x
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
Email
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
x
Email of Department Dean / Chair / Manager
x
Name and Email of Department Dean / Chair / Manager (required)
Please select...
Terry Highstreet
Winnie Kwofie
Jason Singley
Danika LeDuc
Wendy Ng
Pat Jennings
Linda Dobb
John Wenzler
Paul Carpenter
Jason Carmichael
Christopher Chamberlain
Christopher Chamberlain
Terry Highstreet
Winnie Kwofie
Bethany Hobbs-Helmus
Darrell Bailey
Allison Kern
Debbie Chaw
Jason Carmichael
Brian Cook
Robert Phelps
John Wenzler
Michelle Parker
Terry Highstreet
Winnie Kwofie
Mark Almeida
Martin Castillo
Terry Highstreet
Winnie Kwofie
Bethany Hobbs-Helmus
Darrell Bailey
Allison Kern
Jason Carmichael
Paul Carpenter
John Wenzler
Linda Dobb
Jake Hornsby
Pat Jennings
Wendy Ng
Pat Jennings
Wendy Ng
Jennifer Luna
Mark Almeida
Martin Castillo
Terry Highstreet
Jennifer Luna
Mark Almeida
Martin Castillo
Terry Highstreet
Bethany Hobbs-Helmus
Allison Kern
Darrell Bailey
Jason Carmichael
Paul Carpenter
Mark Almeida
Martin Castillo
Andrea Wilson
Jennifer Luna
Mark Almeida
Terry Highstreet
Winnie Kwofie
Pat Jennings
Wendy Ng
Danika LeDuc
Jason Singley
Terry Highstreet
Winnie Kwofie
Emil Asadulla
Shauna Hong
Terry Highstreet
Winnie Kwofie
Pat Jennings
Wendy Ng
Terry Highstreet
Wanda Davenport
Name of Building Key Representative (required)
Please select...
Terry Highstreet
Winnie Kwofie
Jason Singley
Danika LeDuc
Wendy Ng
Pat Jennings
Linda Dobb
John Wenzler
Paul Carpenter
Jason Carmichael
Christopher Chamberlain
Christopher Chamberlain
Terry Highstreet
Winnie Kwofie
Bethany Hobbs-Helmus
Darrell Bailey
Allison Kern
Debbie Chaw
Jason Carmichael
Brian Cook
Robert Phelps
John Wenzler
Michelle Parker
Terry Highstreet
Winnie Kwofie
Mark Almeida
Martin Castillo
Terry Highstreet
Winnie Kwofie
Bethany Hobbs-Helmus
Darrell Bailey
Allison Kern
Jason Carmichael
Paul Carpenter
John Wenzler
Linda Dobb
Jake Hornsby
Pat Jennings
Wendy Ng
Pat Jennings
Wendy Ng
Jennifer Luna
Mark Almeida
Martin Castillo
Terry Highstreet
Jennifer Luna
Mark Almeida
Martin Castillo
Terry Highstreet
Bethany Hobbs-Helmus
Allison Kern
Darrell Bailey
Jason Carmichael
Paul Carpenter
Mark Almeida
Martin Castillo
Andrea Wilson
Mark Almeida
Jennifer Luna
Winnie Kwofie
Terry Highstreet
Pat Jennings
Wendy Ng
Danika LeDue
Jason Singley
Winnie Kwofie
Terry Highstreet
Emil Asadulla
Shauna Hong
Terry Highstreet
Winnie Kwofie
Pat Jennings
Wendy Ng
Terry Highstreet
Wanda Davenport
Name of Building Key Representative (required)
Name of Director, Facilities Operations (required for Grand Master Keys and Building Master Key ONLY)
Additional Notes
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