Locknetics Door Access Request

Please fill in all blanks. Reference list on reverse side for door and department names, and work areas.

Date Requested: / Texas State University ID#:
Applicant’s Name: / Department and Phone #:
Applicant’s Email: / Applicant’s Cell Phone #:
Work Area and Rm #: / Org Officer Title:
Job Title:
Circle One » / Staff Student Grad / Other: Contractor / (ex: Chartwell’s. Rockford)
Room Number Below: / Supervisor’s Printed Name Below: / Supervisor’s Signature Below:
My signature above indicates my department understands that this person has permission to have access to these area and if the i-button isn’t returned by the student or staff upon their departure that my department will be charged and required to pay a $15.00 fee.
OFFICE USE ONLY
Type of Entry use: i-Button ____ Pin ____ Card ____ / Please write down the times you would like for this person to have access. We will determine the times
Activation Date: / available according to the building hours of operation.
Space provided below:
Expiration Date:
Group:
ID# off black i-button:
ID# off gray i-button:
Hot Stamp #:
Serial #:
Building Ops Supervisor Approval:
Entered into system by: / Date:
Removed from system by: / Date:
I have read the agreement, signed the form on the back and received my i-button: / Date:

This form can be found on LBJ Student Center Website under the Services tab, Building Operations, Locknetics Door Access Request Form. Please print on SALMON color paper (Staples #678824). Building Operations has paper if you need it. Print front and back on long side. Please type information except for signatures.

Locknetics Door Access Request

I am responsible for the Student Center i-button issued to me and agree to report the loss, theft or damage immediately to the Building Operations Supervisor as well as to my supervisor or department head. I agree to pay $15.00 for each i-button lost, damaged or stolen. The i-button will not be replaced until the lost i-button is paid for.

2. The i-button issued to me may not be transferred or loaned to another person. I understand that unauthorized use, or possession of a Student Center i-button is not allowed and that if I am found negligent, I may be required to return any or all i-buttons.

3. All i-buttons will be returned to the Building Operations Administrative Assistant or Supervisor upon my transfer to another department, termination of employment, withdrawal from school, or when the use of the i-button becomes unnecessary or unauthorized.

4. For Students, Grad Assistants, and Interns: I understand that if I fail to return the keys issued to me by my last day of employment, the Student Center will refer the matter to department you were assigned.

5. For Staff: I understand that if I fail to return the keys issued to me by the last day of employment, the matter will be referred to the VPSA office and a hold will be placed on my final paycheck(s) until the matter is resolved.

This signature only indicates I understand above rules.

SIGNATURE:

Door # / Door Name / Department Names/Initials / Door # / Door Name / Department Name
CFA Archives / 1st floor CFA Archives (2nd and 4th floor cages) / 2nd and 4th floor cages / 4-2.8 / Veteran’s Alliance / Campus Activities & Student Organizations(CASO)
1-2.4 / Lyndon’s (au-bon-pain) / Chartwell’s / 4-3.1 / NTSO / CASO
1-3.1 / Starbucks / Chartwell’s / 4-4.1 / SACA / CASO
1-4.8 / George’s / Student Center Services (SCS) / 4-5.1 / ASG / Dean of Students (DOS)
1-5.1 / Boko’s / Student Center Services (SCS) / 4-6.1 / Panhellenic/IFC/SOC / Dean of Students (DOS)
1-M.6 / 5th Fl Archives / 5th floor offices cages and storage / 4-7.1 / Cat Camp, Bobcat Build, SVC / CASO
2.S3A / Golf cart entrance ext. door / Staff entrance / 4-8.1 / NPHC/MGC / Dean of Students (DOS)
2.S3B / Golf cart entrance int. door / Staff entrance / 4-9.1 / USAC / Multi-Cultural Student Affairs (MSA)
2-10.4 / Paw’s Market / Student Center Operations (SCO) / 4-10.1 / CASO – Terrie Bonner’s Ofc / CASO Assoc. Director’s Suite
2-11.3 / Information and Building Mgrs / Student Center Services (SCS) / 4-11.1 / Campus Activities / CASO
2-12.1 / SCS Ofc (Res/Info/setup) / Student Center Services (SCS) / 4-12.1 / Student Foundation / Student Foundation (SF)
2-13.1 / Business Office / Business Office (Bus Ofc) / 4-13.1 / Marketing (PALM) / PALM Marketing (Mktg)
2-13.7 / Debbie’s Office / Business Office (Bus Ofc) / 4-14.1 / Student Affairs Technology / Student Affairs Technology
2-15.2 / Chemical Room / Building Operations (Bldg Ops) / 4-16.1 / TT exterior / Student Affairs Technology
2-15.5 / Building Operations / Building Operations (Bldg Ops) / 4-16.3 / Comp Serv TT interior / Student Affairs Technology
2-15.8 / Bldg Ops Super’s Office / Building Operations (Bldg Ops) / 4th Fl Strwell2 / 4th Floor Stairwell2 / Used by Associated Student Govt, Student Affairs Technology
2-16.10 / LD (Loading Dock Ramp) / 5-1.16 / ADCS / Alcohol Drugs Compliance Services
2-16.4 / 2nd Floor Storage / Building Operations (Bldg Ops) / 5-1.5 / Attorney for Students / Attorney for Students
2-5.1 / Lair Kitchen/Offices / Chartwell’s / 5-2.2 / MSA / Multi-Cultural Student Affairs
2-9.1 / ID Services / ID Services / 5-4.1 / Counseling Center / Counseling Center
2nd Fl Hwy1 / 2nd Fl Hallway 1 / Hallway used by Retail, Bus Ofc, SCS (Reservations) / 5-5.1 / Office of Disability / ODS
2nd Fl Hwy2 / 2nd Fl Hallway 2 / Hallway used by Retail, Bus Ofc, SCS (Reservations) / 5-7.1 / Career Services / Career Services
2nd Fl Hwy 2B / 2nd Fl Hallway 2B / Hallway used by Retail, Bus Ofc, SCS (Reservations) / 5-8.1 / Leadership / Dean of Students Leadership Office
3-1.23 / 3rd Fl Atrium / Welcome Center / 5-9.1 / Dean of Students and Multi-Cultural Student Affairs Lounge / Dean of Students and Multi-Cultural Student Affairs (DOS and MSA)
3rd Fl Stairwell2 / 3rd Floor Stairwell 2 / Associated Student Govr. (ASG), Student Affairs Technology / 5-9.2 / DOS Receptionist Door / Dean of Students (DOS)
3-18.1 / AV Room / Student Center Services (SCS) / 5-9.7 / DOS Break room Door / Dean of Students (DOS)
4-1.6A / Palm Office / Programming, Assessment & Leadership Office (PALM)
4-2.4 / CASO Mailroom / Campus Activities & Student Organizations(CASO)

Locknetics Door Access Request FormJune 20, 2013