Chavez Basement Cardkey Application

Cardkey Application

for access to Cesar Chavez Basement
I am

StaffFacultyGraduateUndergraduate

Cardkey Application

Student Musical Activities
Card Number*
See back of Cal ID Card. The first 5- or 6-digits of the bottom right number.
Full Name*
Group*

BandBand (ExComm)ChoralJazzJazz (Equipment Manager)Wind EnsembleOther
Email Address
example@example.com
Student/Employee ID*
Expected Grad Date
e.g. Spring 2026, Fall 2043
Work Address
Work Phone

Campus Extension
Cal ID Front Side*

Browse Files

Cancelof
Cal ID Back Side*

Browse Files

Cancelof
Cardholder Agreement

Please read the following carefully.
I, {fullName}, understand and agree that the cardkey issued upon approval of this request is the property of the Regents of the University of California and

(a)

that the cardkey will be returned upon request or at the time of separation from UC employment or when ceasing to be a member of a Student Musical Activities group,

initial here* — I understand the above statement.

(b)

that I will report its loss or theft to the University Police Department and to the issuing department as soon as such loss or theft is noted, and

initial here* — I understand the above statement.

(c)

that the cardkey is issued for my exclusive use and may not be duplicated, loaned, or used to allow any unauthorized person into a controlled area.

initial here* — I understand the above statement.
I further understand and agree that my full cooperation will be expected during any investigation concerning a security matter which might have occurred in a controlled facility during a time when my presence in the facility has been recorded by the system.

Abuse of the cardkey privilege and/or non-compliance with this agreement is a violation of Penal code 469, and may result in the revocation of cardkey use and/or disciplinary or criminal action.
Cardholder's Signature*

Clear
Date

MonthDayYear
Date
Should be Empty:

Cardkey Application

Cardkey Application

Cardholder Agreement