Given Name Family Name Student/Employee Number Address Kingston Address Address 2 City/Town Province Postal Code Kingston Telephone Number Office Room Number Office Telephone Number Email Status Undergraduate Graduate Staff Other Please specify… Supervisor's Name Supervisor's Queen's Email NOTE: The cost of a set of keys is $45.00, payable to Queen’s University by cheque, cash, or online payment. (If paying by cash, the exact amount is required—we do not make change). $40.00 of this fee is refundable when all keys and proximity card are returned. The provision of a key(s) and/or proximity card is conditional upon the endorsement below of the supervising professor involved and the agreement of the applicant to comply with all the rules listed below. Start Date The date from which keys are required. End Date The date one which the keys will be returned. Proximity Card Access (Fob) Area Room Number Key Requested Animal Care Animal Care Room Number Animal Care Key Requested Aquatic Facility Aquatic Facility Room Number Aquatic Facility Key Requested Biosciences Building Biosciences Building Room Number Biosciences Building Key Requested Chemical Engineering Chemical Engineering Room Number Chemical Engineering Key Requested Darkroom 1421 Darkroom 1421 Room Number Darkroom 1421 Key Requested Environmental Studies Environmental Studies Room Number Environmental Studies Key Requested Graduate Study Room Graduate Study Room Room Number Graduate Study Room Key Requested PEARL PEARL Room Number PEARL Key Requested Upon submitting this form, you are agreeing to the following:The key(s) to doors in the BioSciences Complex issued to me are to be used to expedite/make possible work essential to my biology course(s).I will lend the key(s) to no one.I will admit no one to the BioScience Complex.I will not “block” any door to permit later entry to someone else.I will ensure that any door I open closes securely behind me.I will leave equipment I use in a safe condition and position and will not move any equipment from one room to another.I will return the key(s) and/or proximity card as soon as the need described on the application is over. I will not retain key(s) and/or proximity card beyond the required period without re-application of their use. Failure to return key(s) and/or proximity card shall result in forfeiture of my deposit.If I lose my key(s) and/or proximity card, I will pay an additional $45.00 deposit for a replacement set of key(s) and/or proximity card.Any person who does not abide by these conditions will lose key and/or proximity card privileges and/or withholding of marks/degree until all keys are returned/accounted for.Using your Proximity Card leaves an electronic record which can be used to verify door entry/exit.Key Pick-up and Drop-off times will be Tuesdays and Thursdays from 9:30am to 11:30am
