Electronic Access Request Form

Requestor's Name-Must be Department Head or Supervisor: *

Date of Request: *

Department Head or Supervisor's Contact Phone No: *

Department Head or Supervisor's Email: *

Department: *

Name of Individual(s) Needing Access-If multiple individuals, you may send a list via email to onecard@richmond.edu: *

UR ID No: *

Building(s)/Room(s) Needed: *

Start Date: *

End Date (If Applicable):

Access Needed (Check all that apply): *

24/7 Access Restricted Hours Other

If restricted or other, please specify hours:

Requestor Signature: *

Requestor Title: *

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