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




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public safety

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
  Chaffey College Phone Number
  Employee ID Number
  E-Mail Address
  Supervisor's Name
  Supervisor's Title
  Key(s) needed for this Location
  Room Number
  Door Number
  Additional notes and comments
  * Entry required in this field

Rev. 5/20/14

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CHAFFEY COLLEGE • 5885 Haven Avenue, Rancho Cucamonga, CA 91737-3002 • 909/652-6000
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