Campus Access Request

1
Name* This field is required.
First Name
Middle Name
Last Name
2
Lyon Email* This field is required.
example@example.com
3
Lyon ID Number* This field is required.
4
Reason for needing access:* This field is required.
Huge
Large
Normal
Small
Ok
Ok
5
Locations need access to:* This field is required.
Huge
Large
Normal
Small
Ok
Ok
6
Days/times needing access:* This field is required.
Huge
Large
Normal
Small
Ok
Ok
7
Name of supervisor/instructor/coach who can confirm this need:* This field is required.
8
Have you experienced any symptoms related to COVID-19 in the last 14 days?* This field is required.
YESNO
9
Have you been around anyone who has tested positive for COVID-19 in the last 14 days?* This field is required.
YESNO
10
Have you traveled outside Independence County in the last 14 days?* This field is required.
YESNO
11
Where, outside of Independence County, have you traveled in the last 14 days?
Should be Empty: