Faculty Handbook
Access Request Form
Please use this form to request any type of access: keys, codes or card access. Forms should be emailed to gulbrandsen@wcsu.edu or mailed to the WESTCONNECT Card Office in Old Main. You may also fax the form to 837-9317. Telephone: 203-837-9311.
| Name____________________________________________ | WCSU ID#_________________________________ | |||||||||
| Dept:____________________________________________ | Phone #___________________________________ | |||||||||
| Position: | Full-Time Faculty | Part-Time Faculty | ||||||||
| Staff | Contractor | Student | ||||||||
| Authorized by:___________________________________________________________ (Dept. Chairperson or Director) | ||||||||||
| Lock Change - Please check this option if you would like the locksmith to re-key the lock and issue a new key(s). | ||||||||||
Please complete the first 3 columns
| Building | Area/Room # | Expiration Date (**) | Item Issued (Kay/Card/Code) |
Type of Request (New/Replacement/Lock Change) |
**All part-time employees, contractors and students access expires at the end of each semester. To renew access, please submit a new Access Request Form for each semester.
Receipt & Responsibility Statement
I accept the above keys and/or care and code with the following understanding:
THE KEY/CARD/CODE IS THE PROPERTY OF WESTERN CONNECTICUT STATE UNIVERSITY AND IS ON LOAN TO ME. USE OF THIS KEY/CARD/CODE IS INTENDED SOLEY FOR MY PERSONAL USE AND SAFEGUARDING AND WILL NOT BE GIVEN/LOANED TO ANYONE OR DUPLICATED. IN THE EVENT THIS KEY/CARD/CODE IS LOST, STOLEN, MISPLACED OR COMPROMISED IN ANY WAY, I WILL NOTIFY THE UNIVERSITY POLICE DEPT. I UNDERSTAND THAT SHOULD I LOSE THIS KEY/CARD/CODE, I WILL HAVE TO PAY THE APPROPRIATE REPLACEMENT CHARGES ACCORDING TO THE FAIR MARKET VALUE OF REPLACEMENT. IT IS MY FULL RESPONSIBILITY TO RETURN THIS PROPERTY TO THE OFFICE OF PUBLIC SAFETY IN THE EVENT I LEAVE WCSU EMPLOYMENT AND SHOULD I FAIL TO DO SO, THE UNIVERSITY MAY TAKE THE APPROPRIATE LEGAL ACTION TO RECOVER IT’S COST ($25.00 FOR REKEYING, PER DOOR)
| Signature (upon receipt):X______________________________________ | Date:_________________ | ||||||
FOR OFFICE USE ONLY |
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| ========================================================================================= | |||||||
| Date Received___________________ Date Complete_____________________ KR#__________________ | |||||||
| Date Notified_____________Notified By________________ | Phone | Voicemail | |||||
| Date Issued_____________ Issued By__________________ | Inventory: | ____Keytrail | |||||
| ____Vax | |||||||
| ____Alarm List | |||||||
