Rev. 09-05-19
Lamar State College - Port Arthur
KEY / LOCK AUTHORIZATION REQUEST
This form requires signatures and, therefore, must be printed out, completed and returned to:
LSC-PA PHYSICAL PLANT DEPARTMENT
300 LAKE CHARLES AVENUE
(Copies may be downloaded from the LSC-PA homepage or picked up at the Physical Plant Office)
Note: This form must be printed out in hard copy as it requires signatures.
Check the appropriate box(s) indicating services requested:
□ KEY REQUEST □ DESK / FILE LOCK CHANGE
□ LOCK / CORE CHANGE* □ PADLOCKS
□ LOCK FUNCTION CHANGE □ HIGH SECURITY LOCK / KEY
□ DESK / FILE KEY REQUEST
Assigned to: Date:
P00_______________ Department: ____________________ Position: _____________________
PLEASE PROVIDE A CONTACT NUMBER:
Key / Core #:_______ Quantity:___________ Building: Room Number:___________
Key / Core #:_______ Quantity:___________ Building:___________ Room Number:___________
Key / Core #:_______ Quantity:___________ Building:___________ Room Number:___________
Key / Core #:_______ Quantity:___________ Building:___________ Room Number:___________
Key / Core #:_______ Quantity:___________ Building:___________ Room Number:___________
Acceptance of keys covered by this request is with the understanding that issuance and use will be in
accordance with the Key Control Policy of LSC-PA. IT IS THE RESPONSIBILITY OF THE
PERSON SUBMITTING THIS REQUEST TO OBTAIN SIGNATURES OF APPROVAL PRIOR
TO SUBMISSION.
Approved by: (Department Chair) ______________________________ Date: _____________
Approved by: (Dean, Director or V.P.)___________________________ Date: _____________
Approved by: (President)**____________________________________ Date: _____________
** For master keys, high security keys and keys issued to employees reporting to the President.
FOR OFFICIAL USE ONLY
Approval by: (Physical Plant Director) ____________________________ Date: _____________
