Electronic Security Request Form

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Electronic Security Request Form

Contact Information

Please make sure you have filled in all required fields with valid information.

First Name:

Last Name:

Classification:

Employee
Non-Employee
Student

Employee Classification:

Other Explanation:

Non-Employee Classification:

Other Explanation:

Student Classification:

Department:

Requesting For:

Other Request:

Priority:

Other Priority:

Email:

Requesting For WCU ID #: (if applicable)

Requesting For WCU BID # - 16 digit number on rear of card:
(ex. 60147600XXXXXXXX)

Requesting For WCU SEOS # - 5 digit on rear of card:
(ex. 6A * XXXXX)

Cell Phone:

- Phone (next 3 digits): - Phone (next 4 digits):

Office Phone:

- Phone (next 3 digits): - Phone (next 4 digits):

All contractors cards request must be made two weeks in advance so there are no delays in the issuing process.

Name of Contractor:

Contractor Cell Phone:

- Phone (next 3 digits): - Phone (next 4 digits):

Company Name:

Company Contact Person:

Company Phone Number:

- Phone (next 3 digits): - Phone (next 4 digits):

Background Check Document:

Yes
No

Dates and Times:

Location of Area:

Request Information

Please make sure you have filled in all required fields with valid information.

Application:

Other Application:

Type of Request:

Other Request Type:

Cost Center:

Action:

Other Action:

Schedule Start Date:

Schedule End Date:

Schedule Start Time:

Schedule End Time:

Campus:

Building:

Other Building:

Floor:

Other Floor:

Door Number:

Room Number:

Outside Location:

Other Outside Location:

Parking Lot:

Other Parking Lot:

Garage Location:

Other Garage Location:

Description of Request:

Purpose of Request:

Description of Problem:

Miscellaneous Information:

Approver Information (The below section needs to be completed only when a person is requesting access, and approval is needed for the request that has been submitted.)

Please make sure you have filled in all required fields with valid information.

Approver First Name:

Approver Last Name:

Approver Email:

Approver WCU ID #:

Approver Cell Phone:

- Phone (next 3 digits): - Phone (next 4 digits):

Approver Office Phone:

- Phone (next 3 digits): - Phone (next 4 digits):

Approver Date:

Approver Time:

If you have any attachments that need to be sent to Electronic Security please email them to dps-essupport@wcupa.edu, and make sure the work order number is included in the subject line of the email sent.