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Key Request Form

Person Needing Key/Chip(s):  
    Last Name:  
    First Name:  
    Position Held:  
    Campus Address:  
        Room:  
        Building:  
        MS#:  
    Campus Phone:  
    E-mail:  
    Home Address:  
    Home Phone:  
Date Key/Chip(s) Needed:  
Supervisor Name:  
Supervisor E-mail:  
Key/Chip(s) Requested:  Please list separately.  If no room number is available, describe location. 
    Building/Room Number     
    Building/Room Number  
    Building/Room Number  
    Building/Room Number     
    Building/Room Number  

Duplication of key/chip(s) is strictly prohibited.

Please allow five working days for processing key request.  You will be contacted when key/chip(s) are ready for pick-up.

If a faculty/staff member loses their key/chip, they need to come to the security office (MJH G27) to get a replacement.  The replacement cost for a lost key is $100.00 and a lost chip is $10.00.  If the replacement cost is unpaid, it will be deducted from the faculty/staff member's paycheck.

If a faculty/staff member leaves Clarke and does not turn in their key(s) and chip to the security office, the unpaid replacement costs will be deducted from their paycheck.

If you have any questions, please call extension 8145.

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