Lock-Out Form
You are requesting a lock-out service and are being requested to complete the following information to acknowledge the service you are requesting.
* Required
Student Name (First Last)
*
Your answer
Student ID Number
*
Your answer
*
MM
/
DD
/
YYYY
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Time
:
AM
PM
Staff Performing the lock-out
*
Your answer
By checking this box, you acknowledge that you will be billed $25 for the lockout service. This fee will go directly to your student account and will be payable to the Cashier's Office.
*
I acknowledge and Agree
I acknowledge but would like to appeal the decision understanding there is not a guarantee an appeal will be approved..
If you are appealing the fee, please provide the information you would like to be considered.
Your answer
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