Name of Requestor: Student Faculty Staff Other

Campus Phone #: E-mail Address:
Note: Marywood e-mal address required.

Department: Department Budget #:

Building key is requested for: Room # key is requested for:

Number of keys requested (Note: only numbers can be entered into this box. Please use the box below for additional details.)

Was a key issued to you previously? ? Yes No

Does the key open any other room(s)? Yes No If yes, state room #(s):

Reason access is requested/additional details:

A supervisor must approve this request. Marywood staff members should list their immediate supervisor. Faculty members should list their department chair. Students and others should list the faculty or staff member with whom this request is associated.

Supervisor's name: Supervisor's e-mail: