FACILITIES SPACE CHANGES REPORTING FORM
Facilities Space Management This form is for the approval & notification of CHANGES in facilities space.
Kirk Paul However, it does not include funding approval for the renovation or
713-313-7790 alteration of space. Please follow the usual process to secure funding for
for your space change.
Requesting Date:
Department & Contact Information
Requesting Dept: Contact Name: Phone: Email:
Location of Change
Building: Room: Current Bldg. Liaison:
Note: For a series of rooms or for a whole building, please attach a room number listing with associated changes. Put “attachment” in the room field.
Type of Change
Building
1 Liaison Changed From: To:
2 Department Changed From: To:
3 Room Changed From: To:
Contact
4 Add/Del Explain:
Room No.
PLEASE INCLUDE DRAWING OR FLOOR PLAN WITH NOTES FOR ALL CHANGES. (Room number to be assigned by the Campus Space Planner.)
5 Space Use Space use describes the primary activity of a room such as classroom, office, conference room, storage, laboratory, assembly, etc. Space use cannot
be prorated because there is only one predominant designed use for a room.
Describe use of space:
6 CIP This is the classification of instructional program (CIP) or academic discipline that the space is used for. This would include general use, biological
sciences, visual & performing arts, etc. Because academic disciplines sometimes share space, rooms can be prorated up to 3 times. Must total 100%.
Instructional Program 1: %
Instructional Program 2: %
Instructional Program 3: %
7 Function
The function is often determined by the program’s funding and by whom the program serves. Examples are instructional, research, public service, academic
support, student services, etc. Rooms can serve multiple programs and therefore space can be prorated up to 3 times. Must total 100%.
Program Function 1: %
Program Function 2: %
Program Function 3: %
8 Capacity Student capacity changes in a classroom or class lab require the approval of the Dept. Chair, Dean/Assoc. VP, and Provost or Assoc. Provost.
Changed From: To:
9 Dimensions Explain:
PLEASE INCLUDE DRAWING OR FLOOR PLAN WITH NOTES FOR ALL CHANGES. (Measurements will be taken by the Facilities Planning Dept.)
10 Other Explain:
11 Room Features See page 2 for an alphabetical listing of room features.
Page 1 of 2
Feature Qty
Feature Qty
Feature Qty
Feature Qty
ADA Station
Drwg/Design Tables
Microphone
Sewing Stations
Art Lab
DVD Player
Microwave
Sink
Audio/Visual Devise
Easel
Mini-DV
Sound Equipment
Ballet Bar
Elmo Projector
Mirror
Sound System
Banked Lighting
Eye Wash Station
Moveable Chairs
Sprung Floor
Black & White Printer
Fan
Moveable Desks
Stock Ticker
Blu-Ray Player
Fax Machine
Moveable Tables
Stove
Broadcasting Studio
Fixed Chairs
MP3/MP4 Player
Sympodium
Bulletin Board
Fixed Desks
Nexus System
Tiered-Fixed Seating
CD Player
Fixed Tables
Oven
Tracking Camera
Ceiling Mtd Projector
Flat Panel Screen
Overhead Projector
Tracking Microphone
Ceramic Equipment
ⁱMac Lab
PC
TV
Chalk Board
IT Lab
Phone
Two Way Mirror
Chalk Board With Lines
ITV Equipment
Photography Studio
VCR
Clock
Lab Preparation Rooms
Piano
Vent Hood
Color Printer
Lectern
Powered Screen
Wall Talker Board
Commercial Appliances
Lectern & Microphone
Printmaking Equip
White Board
Computer for Dietary
Lecture Capture
Pull Down Screen
White Board With Lines
Copy Machine
Lighting Equipment
Radiation Area
Writing Center
Critique Rm-Photo
Living Room Set Up
Reading Lab
Cutting Table
Locking Cabinets
Refrigerator
Demonstration Stage
Mac
Rocks
Dining Room
Machine Shop
Rock Cut/Polish Equip
DJ Booth
Maps
RTV Editing Room
Document Camera
Math Lab
Scanner
Drafting Tables
Microfilm Reader
Sculpture Equipment
Chair/Director Dean/AVP VP
OBTAINING or Signature OBTAINING or Signature OBTAINING or Signature
RETAINING RETAINING RETAINING
space: Printed Name space: Printed Name space: Printed Name
Chair/Director Dean/AVP VP
RELEASING Signature RELEASING Signature RELEASING Signature
space: space: space:
Printed Name
Building Printed Name Printed Name
Liaison Signature
(Required for Please send signed originals to Kirk Paul
all changes.) Printed Name at kirk.paul@tsu.edu:
Facilities, Maintenance & Construction
Provost or Assoc
Provost must sign Signature ALL CHANGES TO FACILITY SPACE
ALL CLASSROOM & MUST BE DOCUMENTED THROUGH THE
CLASS LAB change FACILITIES MAINTENANCE & CONSTRUCTION
requests. Printed Name OFFICE.
click to sign
signature
click to edit
click to sign
signature
click to edit
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