VT Chemistry Department Key Request Form

To obtain keys to rooms in Davidson, Hahn or Chem/Physics, this form must be completed in full, signed by the faculty/staff member responsible for the rooms and returned to Linda Sheppard in Davidson 107. All keys orders must be processed through the University Police Dept. and keys made by the University Key Shop. As this process may take up to a week, please wait at least 2-3 days before checking with Linda regarding your key order.

Requestor's Personal Information
Name (please print)	___________________________________________
Soc. Sec. Or ID No.	___________________________________________
Telephone No.	___________________________________________
E-mail Address	___________________________________________

Building and Room Numbers for Keys Being Requested
Room Number	Building
_____________	_____________
_____________	_____________
_____________	_____________

As a condition for being issued key(s) to rooms listed on this form, it is agreed that I will adhere to the following provisions:

• 1) Authorization for possession of the key(s) has been obtained from the supervisor of the accessible space.



• 2) It is agreed that in the event of loss of a key(s) the department will be reimbursed by me for all costs associated with the resetting of locks and the issuing of new keys to all persons having copies of the lost key(s). Billing for such costs will be made via the University Treasurer's Office.



• 3) I will at no time loan or give a key which is issued to me to any other person.



• 4) I agree to return all department keys upon completion of a degree, resignation from school or termination of employment and recognize that failure to do so will result in a block being placed against issuance of the degree, transcript, or final salary check as appropriate.