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.  In order to receive exterior access to the building or certain areas that requires a card entry you will have to possess an UT ID proximity card.  

"*" Indicates a required field.

*DATE:

*Complete Name of Applicant (Last, First, Middle Initial):

*Applicant's UTEID (please write in CAPITAL letters):

*Applicant's Email:

Alternate Telephone number where we may contact you:

*School: *Major:

UNDERGRAD GRAD (Please select one)

UIN # (From UT ID):

*Job Title / Position (e.g. PSY357 student  or  RA):

PAID UNPAID (Please 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.

*Do you have a proximity card? YES NO (You need to have a proximity card in order to have access to exterior building or specific rooms in the building that have card readers.)

*Supervising Professor: *Area:

*Supervising TA: TA Email:

*CAMPUS PHONE:

(NOTE: To obtain promixity card access 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.)