Electronic Access Request – Department of Physics & Astronomy

Electronic Access Request Form for JFB, South Physics, & INSCC

* Indicates a required field.

Name

First/Given

Last/Family

I am a: I am a:

uNID

Email

UCard MagStripe # (All digits after 9840 000# #### ####)

C*Cure # (Only enter the six digits before the space 2*######)

If you are an RA, PostDoc, or Visitor, who is your boss?

Please state why you need access and who will be supervising/be responsible for the activity for which you need access?

Building Access Agreement: The purpose of this agreement is to set forth the terms and conditions under which you are provided access to the Department of Physics & Astronomy buildings. The Physics & Astronomy Department reserves the right to terminate your access privileges at any time, with or without notice, for any reason. You will use the access privilege only for authorized activities and will take such steps as are reasonably necessary to prevent unauthorized use. You will be responsible for managing all persons using the secured facility under access provided by you. You accept financial liability for any loss of University property consequent to granting access, either directly or indirectly (e.g. by propping doors or disabling locks), to a person who does not have access permission. You will not share your access code with any other person. This Agreement shall be governed by the laws of the State of Utah.

I have read and understand the above procedures, agreement & the Key and Electronic Access form. I agree to accept and observe the terms & conditions.

Yes

What Access Do You Want? (Check all that apply)

Account Information

Account Number (Who pays the bill?)

If you are a TA, for what classes are you a TA?

PHYS/ASTRO (i.e. #1010)

Please allow 2 to 3 days to process. If you do not have electronic access within 2 to 3 days, please send an email to Harold Simpson, hsimpson@physics.utah.edu