On-Campus Emergencies:
317-274-7911

Lost Key Report Form

Please fill out all the fields below as completely as possible. If multiple keys were lost and the information will not fit in the space provided, please include the information in the description at the bottom of the report. Fields with an astrik (*) are required. Incomplete forms can not be processed.

*Location of incident:
*Last seen between:

(EXAMPLE DATE & TIME: 1-1-01 at 800 AM)

AND

Person Reporting Loss

*Name
*Department
*Address
Home Phone
*Bus. Phone
E-Mail
Date of Birth
Student/Employee ID Number
*Affiliation with University	** If Other clarify in description below

Key Issued To

Name
Department
Address
Home Phone
Bus. Phone
E-Mail
Date of Birth
Student/Employee ID Number
Affiliation with University	** If Other clarify in description below

Description of Item

*How many key(s) were lost?
What building(s) did the key(s) allow access to?
What room(s) or departments did the key(s) allow access to?
If known, serial number of the key(s)
*Was an Intellikey one of the lost key(s)?	Yes No

*Please describe how the keys were lost:

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Important Partners

IUPUI
Emergency Preparedness

IUPUI Police Department
1232 W. Michigan St.
Indianapolis, IN 46202

On-Campus Emergencies: (317) 274-7911
Telephone: (317) 274-2058
Fax: (317) 274-8031