EDUCATIONAL and GENERAL CAPITAL
REQUEST FORM Fiscal Year 2019/2020
Department Requesting Work:
Scope of Work: Attach supplemental information if necessary.
Justification of Need: (new or expanding “program” requirements, etc.):
Background Data:
a.
Was a “Project Request" or "Space Request” form previously completed?
Yes or No (Check One)
b. Building Name: ___________________________________________________
Building Number: ___________________________________________________
Room Number: ___________________________________________________
Existing Use:
Proposed Use:
c. Existing Space Net Assignable Square Feet (S.F.)
: NASF
d. Proposed Space net Assignable S.F. after
remodeling: NASF
Desired project Completion Date:
Available Funding (Amount & Source):
Chair/Director Print and Sign
Date:
Dean, or Asst/Assoc Vice President Print and Sign Date:
Vice President Print and Sign
Date:
FACILITIES OFFICE USE ONLY:
Maint. Req.:
Minor Proj. Req:
Major Capital:
PLEASE PRINT AND SIGN BELOW
Space Classification (Select one from the drop down menu):
Priority #
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