Requester:
Today's Date:
Phone:
Building
Room No.
Facilities Management
Change in Use or Function of Facility Space Request Form
Refer to Procedure 285.5 for further information
Email:
Please provide description of the requirement and justification.
Requests for modification to
existing classroom, administrative,
or resident space must be submitted
60 days in advance for review and
approval.
Location of Proposed modification:
Supervisor:
For Office Use Only
Additional Information
Has this been discussed with
your supervisor?
Indicate "Yes" or "No" below.
Submit