Lock-Out Form

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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.

Student Name (First Last) *

Student ID Number *

YYYY

Time

Staff Performing the lock-out *

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.

Submit

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