Fillable Space Request Form Request for Space Form

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Space Request Form Request for Space Form

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The Space Request Form Request for Space Form form is 2 pages long and contains:

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Country of origin: US
File type: PDF

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Coppin State University
Request for Space
Policy: All requests for new space or a change in space must be forwarded to the University’s Space
Advisory Committee for the review and approval process. Please complete the form and print or save
as a pdf file. E-mail to:
CONTACT INFORMATION:
Requesting Department: Date:
Name: Phone: Email:
DESCRIPTION OF SPACE NEED:
1. Space will be used for:
Instruction
Research
Administration
Storage
Computer Lab Other_______________
2. Space will be used by: Faculty Administrator Staff Students Other_________
Number of occupants: _____________
3. Have you identified a preferred space? Yes No
4. If Yes, which building & room no.:
5. Will you be vacating your current space? Yes No
6.
Will there need to be any remodeling or enhancements?
Yes
No
If Yes, will you require Information Technology Services Electrical Services Construction
Painting
Other __________________
7. Please briefly describe how the space will be used and why new/additional space is needed: (
Attached
additional page
if required)
8.
How will the new space support the University’s Goals and/or Department’s Strategic Plan:
9. Will this be a temporary placement? Yes No
10. Do you have funding available to cover the cost related to this request? Yes No
11. Date Needed:
AUTHORIZATION SIGNATURES:
Department Head: Approved Disapproved Date:
Dean/Director: Approved Disapproved Date:
Vice President: Approved Disapproved Date:
Planning, Construction, and Information Technology Review/Evaluation Comments:
Estimates $: ______________________________________ Date: ______________________________
Space Utilization Advisory Committee Recommendation: Date: ____________________________
_____________Approve ____________Deny
Comments:
Final Approval
Provost: ________________________________________________________ Date: ____________________________________
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Space Request Form Request for Space Form

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Completed 17 November 2019

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