Micro and Nanotechnology Laboratory
Keycard Request/Change Form

The following form is provided to users of the Micro and Nanotechnology Laboratory as a convenient means of requesting a keycard for access to the laboratory. You can also get a printed copy at the MNTL Business Office. After you take the Building Safety Training you can stop in the business office to pick up a proximity i-card form, which is $8.50.

Keycard Request Form












provided by P.I.
BANNER Account Number*
provided by P.I.
1 - - - -

Building and Room Number*
Street*
City*
State*
Zip*
Work Phone*

Permanent Home Address

Street*
City*
State*
Zip*
Home Phone*

For U of I Personnel Only*
Faculty
Academic Professional
Staff
Postdoc
Graduate Student
Undergraduate Student
Other

Other Labortory Users*
Industry
Other University
Government Lab

Request the following access*
Building Entrance
Cleanroom Suite
BioLab

*required items