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CCBN Card Access Authorization

Card Access Authorization forms will be submitted by the Department. Please email Amanda Mauthe-Kaddoura (amanda.mauthe2@uleth.ca) with the following information:

I authorize the:
  • ACTIVATION
  • CONTINUATION
  • DELETION
Please select appropriate choice.
For card access rights to:
  • OUTSIDE DOORS
  • ANIMAL SIDE
  • CCBN LOADING DOCK
  • MRI MAIN DOOR (EP1250)
  • MRI CLINIC (EP12H13)

Please select appropriate choice.

for Name:
U of L ID#:
Effective as of (Date):
Expiry Date (If Applicable):

Duration should cover expected tenure, eg., master student -2yrs, PhD student 4 yrs, PI 5 yrs, Staff 5 yrs.