The University of Memphis

Request for Building Access
For Student/Temporary Employees & Agents of the University

Please allow a two-week minimum turnaround time after submitting form.
Submit form to BFSS, Admin Bldg, Room 151
Building Access/Key Control Policy UM1567
Requester Information: FOB Information:
Student Temporary Employee Agent Issue New Fob
Deactivate Fob
Replace Fob
Lost
Damaged
Reassign Fob
Update Access

Add Remove Access to Building Name(s):


Previous Owner and Fob Number:
Only For FOB Reassignments
Name:
Username:
Banner UID:
Position Number: 
Job Title:
E-Class:
Department:
Phone
Activation Date:  
Deactivation Date:  
One Year Maximum

As a student/temporary employee/agent of the University of Memphis, I am aware that access to University property is to be treated in a professional and confidential manner. I agree herein, as a consideration of my employment/relationship, that I will not disclose or cause to be disclosed any such confidential information gained in the course of my employment/relationship at any time.

I am aware that any breach of the use of this access or any abuse of my position, including but not limited to alteration of records, destruction of records or other similar acts, may result in disciplinary action or constitute a basis for termination of employment/relationship.

Requester Signature:_______________________________________Date____________

Supervisor/Sponsor Signature:_______________________________________Date____________

Comments:
Financial Manager's Name: Username:
Organization Code: Index:

I understand that the ultimate responsibility for any action taken by the above individual and collecting this FOB when access is no longer necessary is mine.

Financial Manager's Signature:___________________________________ Date:___________

Contact Person: Phone: Username (e.g., jsmith):

FOR BFSS USE ONLY:
WO:
Access Level:
The University of Memphis, one of the Tennessee Board of Regents institutions, is an Equal Opportunity/Affirmative Action University.