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New Jersey City University
Capital Request Form
Capital Purchase or Project Request Date: ____________________________
Requestor Name: ______________________
Department Name: ______________________
Cost Estimate: ______________________
Desired Start Date: ______________________
Desired Completion Date: ________________
Describe the capital purchase or project scope in detail (include building, floor, and room #, if capital project):
Describe how this capital purchase or project aligns with the University’s strategic plan. Reference specific plan
goals and objectives of the plan:
Will this capital purchase or project impact the University’s operating budget or individual department budget? If
so, how?
Does this capital purchase or project present a revenue generating opportunity for the University? If so, how?
Is this capital purchase or project related to a health, safety, and compliance priority? If so, how?
Will this capital purchase or project be funded via a grant, individual department budget or other funding source?
Please elaborate.
Chairperson Signature, if applicable: ______________________________ Date: _________
Dean/Director Signature: ______________________________ Date: __________
Vice President Signature: _______________________________________ Date: __________
(Divisional VP supports the initiatives outlined in this request)
Note: Forward to Facilities or IT for cost estimate validation.
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