PLEASE NOTE: Only Graduate Students, Faculty and Staff of the Psychology department may complete and submit this form. Verbal confirmation is required for submission if the Applicant (for whom the key slip will be issued) is not the person completing this form.

After this request form is submitted and processed a key slip will be issued, which in turn may be redeemed at the Lock and Key Services department for a key. Key slips will be kept in Room 4.212 until claimed. Card access forms are sent separately to the Keys and Locks department. You generally should be able to pick up access cards at Lock and Key services within 1-2 days of request.

NOTE: To obtain a key card for a person other than a Psychology graduate student, faculty or staff member, a separate written authorization must be submitted. Please see Cathy Rodriguez in 4.212 for assistance with this matter.)

Applicant Information

"*" Indicates a required field

*DATE:

*COMPLETE NAME OF APPLICANT (Last, First, Middle Initial):

*APPLICANT'S EID:

*APPLICANT’s EMAIL:

ALTERNATE PHONE NUMBER WHERE WE MAY CONTACT YOU:

UIN # (From UT ID):

*JOB TITLE / POSITION:

PAID UNPAID (Select one)

*FUNCTION (e.g., running subjects, coding data):

*KEY(S) REQUESTED:

(If in a suite, specify room: e.g., 4.208a, not just 4.208. If only requesting keycard, write none.)

*KEY CARD REQUESTED? Yes No

*SUPERVISING PROFESSOR:

*AREA:

*SUPERVISING GRA:

EMAIL:

*CAMPUS PHONE: