Facilities Planning and Management
PROJECT REQUEST FORM
SECTION 1 – PROJECT REQUESTOR/ SCOPE:
From Department:
Date:
Project Contact Person (Name):
Contact No.: Email:
Projected Requested By (Name):
If different than contact person.
Contact No.: Email:
Project Location/ Bldg.: Room(s):
Project Description/Scope: Describe in the space below what you would like to have done. Attach a map and additional materials if
necessary.
Project Justification: Include the reasons for the change as well as the last changes to this area and how the project supports the
academic mission of the College. Attach a map and additional materials if necessary.
Service Requested (check all that applies):
_______ Consultation _______Preliminary Estimate _______Final Estimate ________Implementation
Desired Completion Date: _______________________ If other than routine scheduling is required, please explain below.
Relocations required: ___ Yes __ No
SECTION 2 – BUDGET INFORMATION
Budget Code:___________________________________ No funding identified at this time.
Funding Amount Available: $______________________
Print Name:_________________________________________
Department Signature: _________________________________________ Date: _______________________
SECTION 3 - APPROVALS
Director/Dean Signature/Date: Print Name:
VICE PRESIDENT APPROVAL
VP Signature/Date: Print Name:
3/6/12
Please com
lete & return to Facilities Plannin
& Mana
ement.
ProjectNumber
(AssignedbyFPM)
click to sign
signature
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signature
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