RHO "About Me" Form

Residence Life Lockout Form

When a resident is locked out of their room space and need assistance, they need to complete the lockout. Each lockout fee is $5 and each lost key replacement is $80. All fees will be charged to the resident's student account.

Upon completing / signing this form, acknowledges lock out has been completed and resident will be responsible for all charges.

If you have any questions, please contact Residence Life.

Thank you!

Lockout Date:

Date

Lockout Time:

Hour Minutes

AM/PM Option

Resident's First Name:

Resident's Last Name:

Resident's Residence Hall

Resident's Room Number:

Did Resident Lose Key or Port Pass?

Spare Key Issued?

ResLife Staff Completing Lockout:

Additional Notes:

If Applicable

Resident Signature:

Additional Notes:

You can include any notes you want Pro-Staff to know.

Was a spare key issued?

Resident's Signature