Access Request Form

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Chaffey College
Department of Public Safety
5885 Haven Avenue
Rancho Cucamonga, CA 91737

CAMPUS POLICE

Emergency
909-652-6911

Business
909-652-6632

Error processing SSI file
Access Card / Key Request Form

The contents of this form will be sent to the appropriate campus departments for processing and recordkeepping. Please allow reasonable time for the processing of your request. Key requests require a minimum of 24 hours notice. Questions should be directed to the public safetydepartment at extension 6632. Thank you!


	Date Request Submitted *
	Requested By All requests for access cards and keys must be made by the employee manager or designee. Full Name * Email Address *

	Employee Information First Name * Middle Name or Initial * Last Name *
	Job Title *
	Department *
	Chaffey College Phone Number *
	Employee ID Number *
	E-Mail Address *

	Supervisor
	Supervisor's Name *
	Supervisor's Title *

	Key(s) needed for this Location
	Building *
	Room Number *
	Door Number

	Additional notes and comments
	* Entry required in this field

Rev. 8/21/12