Xlab Card Key Access Request Form
Principal Investigator or Faculty Advisor *
Name
Your answer
*
Email Address
Your answer
Recipient Last Name *
Name as exactly on the Cal ID
Your answer
Recipient First Name *
Name as exactly on the Cal ID
Your answer
Recipient Middle Initial
Your answer
Recipient Student/Employee ID # *
Your answer
Recipient Card Number at the back of the Cal ID card *
First 10 digits at the lower right corner
Your answer
*
Recipient's Status
*
Recipient's Email Address
Your answer
*
Recipient's Phone Number
Your answer
Reason *
Your answer
Duration of Use *
Your answer
By signing my name below, I accept the responsibility of card key access to the Xlab. I will be responsible and report the loss/theft of my Cal ID immediately to the Berkeley Police Department. I will not lend out or give any issued my Cal ID to anyone.
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