Rev. 11/13/2019
LAMAR STATE COLLEGE PORT
ARTHUR
FACILITIES SPACE CHANGE AND ALLOCATION
REQUEST FORM
Requesting Department: Date:
Name:
Phone: Email:
A. Change that increases or decreases room or building square footage?
Yes
No (If Yes see below)
A. 1. Building Name: _________________________________________
A. 2. Room Number: ____________
A. 3. Change square footage From: To:
B. Change in Capacity of a classroom, class lab, meeting or assembly room?
Yes
No (If Yes see below)
B. 1. Building Name: _________________________________________
B. 2. Room Number: ____________
B. 3. Change Room Capacity From: To:
C. Change Affecting How a room is utilized (Purpose or function of the room)
Yes
No (If Yes see below)
C. 1. Building Name: _________________________________________
C. 2. Room Number: ____________
C. 3. Space will be used for:
□ Instruction ______% General Academic ______% Vocational/Technical
□ Administration □ Storage □ Support
□ Other, please specify _______________________________________
C. 4. Space will be used by:
□ Faculty □ Staff □ Students
□ Other, please specify _______________________________________
C. 5. Bri
efly describe this change and any special considerations. (Use additional sheet if necessary)
D. Relocation of faculty, staff or others from one location to another.
Yes
No (If Yes see below)
D. 1. □ Faculty □ Staff □ Other, please specify _______________________________________
D. 2. From Building: ______________________________ To Building: ______________________________
D. 3. From Room: ____________ To: Room: ____________
D. 4. If Faculty: Please provide Name, Title, Department
, Academic Discipline and if courses taught are degree
related or non-degree related or Not Applicable. (All fields are required)
Name: _______________________________________________________________________
Title: ________________________________________________________________________
Department: __________________________________________________________________
Academic Discipline: ___________________________________________________________
Courses Taught : Degree Related: ______% Non-Degree Related: ______% Not Applicable _______
D. 5. If Staff: Please provide Name, Title and Department.
Name: _______________________________________________________________________
Title: ________________________________________________________________________
Department: __________________________________________________________________
D. 6. If Other: Please provide Name, Title and Job duties.
Name: _______________________________________________________________________
Title: ________________________________________________________________________