Dorm and number of room or suite to have authorization changed: 

 ______________________________

List name of individuals to receive access to the card lock (be sure to print legibly):

Note: Non-HMC students given access will need to go to Facilities and Maintenance located in the Platt Basement before they will be able to swipe into the room or suite.

1.  ______________________________               6.  ______________________________

2.  ______________________________               7.  ______________________________

3.  ______________________________               8.  ______________________________

4.  ______________________________               9.  ______________________________

5.  ______________________________              10. ______________________________

Names and signatures of people currently living in the area (having default access to the area):

If a dorm-wide authorization is granted, put the name of the group approving access along with the name and signature of the dorm president who conducted the vote of the dorm.

1.  ______________________________                 ______________________________

2.  ______________________________                 ______________________________

3.  ______________________________                 ______________________________

4.  ______________________________                 ______________________________

5.  ______________________________                 ______________________________

6.  ______________________________                 ______________________________

7.  ______________________________                 ______________________________

8.  ______________________________                 ______________________________

9.  ______________________________                 ______________________________

Revised on September 1, 2006 by Guy Gerbick
Dean of Students Office, 301 Platt Boulevard, Claremont, CA 91711
Revised on July, 2010 by Theresa Lauer
Facilities and Maintenance Office, 301 Platt Boulevard, Claremont, CA 91711