Attachment I

Key Issuance Form

NAME: ______________________________________________________________

Circle One: Faculty Staff Student

Address: _____________________________________________________________

TXSTATE ID#: ______________________ PHONE NO: _____________________

DEPARTMENT: ______________________________________________________

ACCOUNT NO.: __________________________

I UNDERSTAND AND AGREE THAT:

1. I am responsible for the university keys issued to me and for immediately reporting their loss or theft to the University Police Department as well as to my supervisor or department head.

2. I may not transfer or loan my keys to another person. I understand that unauthorized duplication, use, or possession of university keys is not allowed.

3. I know only Texas State Access Services may duplicate university keys.

4. I will return all keys immediately to Access Services or my department head upon my transfer to another department, employment termination, withdrawal from school, or when the use of the keys becomes unnecessary or unauthorized.

SIGNATURE: __________________________________________ DATE: ________________

KEY# SERIAL# DATE LOST/DATE RETURNED SIGNATURE