Access Card Request Form
Person Completing the form
Name of Person Completing Form
*
First Name
Last Name
Your Cell Number
Please enter a valid phone number.
Your email
example@example.com
Reason for the form
*
Add a new Access Card
Change Access
Replace Lost or Damaged Card
Delete Access
User relationship to Buildings
*
Employee of Stó:lō Service Agency (INCLUDES PROGRAM RELATED CONTRACTORS)
Building Tenant
Contractor (PROVIDES SERVICES TO OPERATIONS)
Department
FINANCE
OPERATIONS
STÓ:LŌ HEALTH SERVICES
SASET
SRRMC
Other Access
Program Name
Access Cardholder Information
Cardholder's Name
First Name
Last Name
Keyscan Card Number
Cardholder's Email
example@example.com
Cardholder's Job Title
Cardholder's Cell Phone
Please enter a valid phone number.
Cardholder's Date of Birth
-
Month
-
Day
Year
This will be used as your password if you happen to set off the alarm in the building.
Upload a Passport type photo for your card, blank background please.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Supervisor's Name
Supervisor's Cell
Please enter a valid phone number.
Supervisor's Email
example@example.com
Building Information
Hours of Access
*
Monday - Friday (07:00 - 17:00)
Monday - Friday (06:00 - 22:00)
Monday - Sunday (06:00 - 22:00)
Monday - Sunday 24 / 7
Buildings to Access
All Buildings
Individual Buildings
Area of Building to Access
Common Area Access Only
All Building Access
Specific Office Access (provide details in Additional comments below)
Health Employee
ASCD / AIDP Access
Daycare Access
Dental Access
Justice Access
Nurse Access
Stó:lō Elders Lodge
Other Health Access
Tenant Name
Fraser Health Authority
FNHA
FRAFCA
FVAC&FSS
Stó:lō Community Futures
Ts'elxwéyeqw Tribe
Sardis Pharmacy
Serenity Chiropractic
Fraser Valley Child Development Center
Other Tenant Name
Building for Access
Building 1A
Building 2A
Building 2B
Building 2C
Building 2D
Building 5A/B
Building 7
Building 8A/B
Building 9
Building 10
Building 11
Building 19 / 26
Mission - St. Mary's Campus
Stó:lō Elders Lodge
Maintenance Compound
Vehicle Compound
Operations Shed
Events Shed
Building 5
Side Door (East Side)
1st Floor East Door SASET
2nd Floor West Door
5A/B Door
5B Main Door
Building 7
Common Areas
Gym Access (Waiver needed)
Other
FNHA
Building 5a access
Bldg. 7, Office 243
Bldg. 7, Office 244
Bldg. 7, Office 245
Bldg. 7 Basement
All FNHA Access
FVAC&FSS (Xyolhemeylh) - (See Map below)
Office 217
Office 218
Office 219
Office 220
Office 221
Office 222
Office 223
Office 224
Office 225
Office 226
Office 227A
Office 228
Office 229
Office 230
Office 231
Basement
Access to All offices
Qwi:qwelstom - (See Map below)
Office 211
Office 212
Office 213
Office 214
Office 215
Office 216
Office 247
Office 248
Access to all offices
Basement
Other access
Building 7 - 1st Floor
Office 101
Office 102
Office 103
Office 104
Office 105
Office 106
Office 107
Office 108
Office 109
Office 110
Office 111
Office 112
Office 113
Office 114
Office 115
Office 118
Office 119
Office 120
Office 121
Office 122
Office 134
Office 135
Office 136
Office 137
Office 138
Exam 140
Exam 141
Store room 142
Exam 144
Exam 145
Exam 146
Exam 147
New Exam 1
New Exam 2
Other
Building 7 - 2nd Floor
Office 200A
Office 200B
Office 203
Office 204
Office 205
Office 206
Office 207
Office 208
Office 216
Office 232
Office 233
Office 235
Office 239
Office 241
Office 242
Other
Building 8
Building 8A
Building 8B
Other
Building 10
Common Areas
Other
SRRMC
Archeology
Vehicle Compound
Storage Shed in Compound
Building 10 Specific Access
Building 10 Common Areas
Tourism
Other Access
Building 10 SRRMC
Library
Archive Room
Classroom External Door
Public Repository
Archeology Lab
Archeology Lab External Door
Office 201
Office 204
Office 205
Storage 208
Office 210
Office 211
Office 212
Office 213
Office 214
Office 215
Office 216
Office 218
Office 219
Office 220
Office 221
Office 301
Office 302
Office 303
Office 304
Office 305
Other access
TTML (TS’ELXWEYÉQW TRIBE)
Office 310
Office 311
Office 312
Office 313
Office 314
Office 315
Office 317
Office 319
Office 321
Store room 322
Office 323
Basement Storage
Other Access
Stó:lō Elders Lodge
Suite 101
Suite 102
Suite 103
Suite 104
Suite 105
Suite 106
Suite 107
Suite 108
Suite 109
Suite 110
Suite 111
Suite 112
Suite 113
Suite 114
Suite 115
Lost or Damaged Card
Card is Damaged and does not work (Need card Returned)
Card is misplaced and lost (To Replace a Lost card there is a $25.00 Fee)
Additional Comments
Please provide any other access details not identified above
Submit
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