Fillable Change Of Use Form (University of Wyoming)

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Change Of Use Form (University of Wyoming)

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The Change Of Use Form (University of Wyoming) form is 3 pages long and contains:

  • 3 signatures
  • 4 check-boxes
  • 54 other fields

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File type: PDF

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UW Space Assignment and Management
Change of Use Form
Page 1 of 3
Introduction: UW Regulation 2-181 defines space assignment and management at the
University of Wyoming, and outlines how the process is to be carried out. Section two states that,
“It is the responsibility of each administrator with delegated responsibility for space management to
ensure that changes in assignment, classification and function, are reported to the FPO (Facilities
Planning Office).” In addition, “The FPO is available to provide an evaluation of space options and
should be utilized for resolution of space requests.” Additional references are made regarding
participants and their role in the space allocation process; this form is intended to assist in meeting
those responsibilities. Please complete the form and submit to the Facilities Planning Office.
I. Requested By:
__________________________ __________________________
Department College/Division
II. Current Use:
a. Building: _______________________ Room No. _________________________
b. Current Use: ____________________________________
III. Proposed Usage: Please explain the proposed usage of the room.
1. Office Type: Faculty Staff Graduate Students/TA Students Other (please specify
below)
2. Office Service (copier, files, mail boxes):______________________________________________
3. Conference Room - seating capacity: ____________
4. Research Laboratory: Complete Addendum A.
5. Storage/Warehouse: ___________________________________________________________
6. New Department/College/Division:_______________________________________________
7. Other ______________________________________________________________________
IV. Timeline: The time the change in function would occur.
1. Temporarily: Beginning __________________ and ending ______________________.
2. Permanently: Beginning __________________________________.
V. Reasons for Change:
Attach a detailed narrative that follows the below format:
1. Description: Please provide a succinct description of your change request, including what is being
changed and why. Indicate whether this is being driven by a new program, a research grant,
inadequate space to provide current program, and/or other reasons.
UW Space Assignment and Management
Change of Use Form
Page 2 of 3
Submitted/Endorsed by:
______________________________________________
Signature of Dept/Unit Head (date)
______________________________________________
Signature of Dean/Director (date)
______________________________________________
Signature of College Facilities (date)
Coordinator (if applicable)
Name of Department/Unit Contact Person:
_____________________________________
Building:_________________________
Phone:___________________________
Fax:_____________________________
E-mail:___________________________
Unsigned request will not be considered.
Please submit this request to the Department of Facilities Planning, Manager of Space Allocation, Merica
Hall, Room 208. Questions: call 766-2648.
Please note: After approval, it will be the responsibility of the requesting party to obtain cost
estimates from Physical plant for conducting any work or moving expenses. It will be the
responsibility of the requesting party to provide the funding for such expenses.
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UW Space Assignment and Management
Change of Use Form
Page 3 of 3
Addendum A
Teaching Lab
Number of student seats: __________ Number of computers: ___________
Lab type: Wet____, Dry____
Hazards: List all chemical and physical hazards, such as lasers, corrosives, drill press, etc. Attach a
separate list, if necessary.
Chemicals (list) ______________________________________________________
Processes and specific hazards (list) __________________________________________
Fumes Hoods: Number/Size __________________________________________
Waste (specify): Liquid____, Dry____, Biohazard____, Radioactive____
Amount (volume/week) ________________________________________________
_______________________________________________________________________
Are operations covered by an existing safety plan: Yes____, No____
Research Lab
Number of workstations? __________
Lab type: Wet____, Dry____
Hazards: List all chemical and physical hazards, such as lasers, corrosives, drill press, etc. Attach a
separate list, if necessary.
Chemicals (list) ______________________________________________________
_______________________________________________________________________
Processes and specific hazards (list) _________________________________________
_______________________________________________________________________
Fumes Hoods: Number/Size __________________________________________
Waste (specify): Liquid____, Dry____, Biohazard____, Radioactive____
Amount (volume/week) ________________________________________________
_______________________________________________________________________
Are operations covered by an existing safety plan: Yes____, No____
_____________________________
Contract/Grant Effective Dates
_________________________
Total $ Amt. of Agreement
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Change Of Use Form (University of Wyoming)

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Completed 16 July 2020

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