By filling out the following form you have started the process of project competition. Please enter, in fine detail,
your information then print off, obtain necessary signatures and forward to Facilities Management. Your request
will be assessed and you will receive a file number as a reference to your project.
Note: Unsigned requests will be returned. Note: Refer to Fix-it for minor requests.
Building & Room #(s):
Primary Contact Person: Phone # E-Mail:
Department / Research Group:
Funding Source(s):
Department: Grant: A&R: Other:
Current Use Of Area:
Proposed Use Of Area:
Is the space for the proposed project currently part of the department’s allocation? Yes No
Scope Of Work: (provide details of proposed project. Attach sketch. Attach additional details if you run out of space.
Provide detailed list of new equipment.)
Will new services be required? (eg. Plumbing, Electrical, Air Conditioning, Fume Hoods, Data, Phone, etc.)
Justification: (provide reason why project must be implemented)
Scheduling Requirements/Completion Date:
Authorization for Submission:
The above information is to be used by Facilities Management to produce a pre-design cost estimate. I acknowledge that
any future changes may cause delays or result in the need to prepare a revised request.
Please Type Name: Signature: Date:
Approved by: Department Head __________________________ _________________
Building Manager __________________________ _________________
Department Dean __________________________ _________________
Facilities Management Office Use Only
Date Rec’d
Assigned To: Comments