Music Department Access Card & Key Request
Music Department Access Card & Key Request
Online Key Request Form
Name
*
First
Last
PID:
*
Email
*
Student Status:
*
Graduate Student
Undergraduate Music Major
Re-Activate Card
Undergraduate Music Minor (access to lockers M-F 8am-9pm)
Room Request (i.e. practice rooms, etc.):
*
Quarter of Usage:
*
Fall Quarter
Winter Quarter
Spring Quarter
Associated Class/Project:
*
USER ACKNOWLEDGMENT: • Responsible for the security of the room and its contents while the room is open due to the exercise of the user key(s). • Responsible for controlling the use of the card and/or key(s). It is against Music Department policy to loan your card and/or key(s) to others. • Responsible for securing and returning the room to its original condition after it’s use. The user is required to pay a fee of $10.00, checks payable to UC Regents. Failure to return key(s) by due date, loss of key(s), or irresponsible use of key(s), may result in loss of key privileges, and fines covering the actual costs incurred by the Music Department to re-key, change locks or repair damage to equipment or rooms. Issued key(s) subject to recall at any time. Initial:
*
Please allow 3 business days for your request to be processed. You can pick up your Access Card and/or key from room 177 between 9:00 – 11:00 AM Mon- Fri.
Date
*
/
MM
/
DD
YYYY
Comments/Notes:
