Key Request

To:    Facilities & Planning

Date: ____________________________

From:  ________________________________________
                            Dean, Director or Unit Head

Issued to: _____________________________________
                                          Name

[  ] Faculty    [  ] Staff    [  ] Student   [  ] Other   Soc Sec # ______________________

Reason for request: ________________________________________________________________________________________________________
  (If temporary issue, list return date if less than school year).
 

_________________________________________________________
Provost or Vice President's Signature                               Date
 
 

I the undersigned agree to adhere to Eastern's Key Policy and agree to report lost or stolen keys to the School Dean, Director or Unit Head to preserve the safety of individuals and the security of property.  I also agree to the General Policy, Article D that states: Eastern Oregon University will charge a $25.00 penalty for each unreturned key.  The penalty is due and payable immediately.  Failure to pay will result in having the penalty turned over to Accounts Receivable for collection.  In the case of a student, a hold will be put on transcripts and grades until the debt is paid in full.  Students are required to return all campus keys to the Facilities ane Planning office on or before June 15th of each school year.

__________________________________________________________
Key Holder's Signature -- Upon Receipt of Key                       Date