Fillable UIS Space Allocation Committee Request Form (University of Illinois at Springfield)

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UIS Space Allocation Committee Request Form (University of Illinois at Springfield)

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UIS Space Allocation Committee Request Form
The UIS Space Allocation Committee (SAC) reviews all requests for reallocation of physical space located in all University
facilities unless prohibited by contract or funding source obligations, policy or statute. This includes reassignment of
space from one unit to another or space that would involve remodeling/construction. In addition, the SAC will review
major changes in use of space (for example, changing a conference/meeting space or classroom to offices). The
committee will not review requests for moves of personnel within a department’s existing space, such as reassignment of
offices within the same department/center or assignment of space for special events.
I. REQUESTOR INFROMATION: If you need assistance completing the form, please contact Jerry Joseph 206-6003
Requestor (Primary Contact):
Dept/Unit/Center/School:
Phone:
Email:
Date:
II. SUMMARY OF REQUEST:
Request for Additional Space to support new or expanded activity
Request to relocate to a new location
Lease request
III. REQUEST FOR SPACE:
A. Briefly describe why new/additional space is needed. How will this requested space positively impact the educational mission?
Address the implications to your program/service if additional space is not approved. Please supply supporting documentation.
B.
New space will be used for: Instruction Research/Grant Administration Storage Support
Other, please specify:
C. What attempts have been made to locate space within your current space allocation? Has under utilized space been assessed to
solve this need? Have shared space possibilities been explored?
D. Have you identified a suitable location for this new space that may be available? Yes No
E.
If yes, describe, identify building/room #s or attach drawing/floor plans/diagrams:
F. Is the space requested currently occupied? Yes
No
G. If space will be vacated by approval of this request, please indicate if current space will be released? Yes
No
H. Will this space need to be renovated if request is granted? Yes
No
I. If yes, are funds available for the renovation? Yes No
J. Funding source for renovation (CFOP):
IV. SPACE REQUIREMENTS: Please refer to the Space Criteria Form to complete space requirement needs.
V. REQUESTOR AUTHORIZATION SIGNATURES (the signatures below indicate agreement that the space request should be given
consideration. Approval to submit request does not indicate a guarantee of space for the purpose outlined in this request.)
Department Head or Chair or Director:
Comments:
Dean:
Comments:
Vice Chancellor:
Comments:
Forward this completed form with the proper signatures and supporting documentations by inter-campus mail to Gerard Joseph,
MS PAC 525.
VI. UIS SPACE ALLOCATION COMMITTEE ACTION
Date received by Committee:
Date reviewed by Committee:
Action recommended by Committee:
Requestor Notification Date:
Assigned Space:
Comments:
Submission Deadline: The 25th of the month
Committee Review: Second Friday of the month or as posted
SPACE CRITERIA FORM
SPACE NAME:
TYPICAL OCCUPANCY:
PRIMARY FUNCTION/UTILIZATION OF THE SPACE:
Special Requirements:
1) Minimum square footage or space dimensions:
• Ceiling height:
• Special dimensions to fix specific type of equipment of furniture:
2) Special Finish Materials:
• Floor:
• Walls:
• Reinforced wall construction to support any equipment or fixtures hanging on wall (to include dry erase boards):
• Ceiling:
• Acoustics:
• Signage:
• Door size:
3) Special Heating/Cooling and Ventilating Requirements:
• Heating:
• Ventilating:
• Cooling:
• Humidity control:
• Plumbing (water, sewer, specialized drains, oil/water separator, eye/body wash, natural gas, compressed gas or
air, etc…):
• Specialized cooling for electronics / servers / computers:
4) Specialized fire detection, suppression or protection:
5) Electrical:
• Special power requirements for equipment:
• Dedicated ground outlet required?
• Isolated ground outlet required?
• Uninterrupted Power Supply (UPS) required?
• Special Lighting/Controls:
• Is daylight required?
6) IT / Communications / Audio Visual:
• Local Area Network / Wireless Access Point:
• Telephone:
• Public address system:
• TVs / Monitors:
• CCTV:
• Projector & screen:
• Computers:
• Printers / Copy Machines:
• Facsimile:
• Other Audio Visual requirements:
7) Security:
• Key Lock
• Key Pad (electric)
• Access control system
• Intrusion detection system
• Cameras
• Other Special requirements
8) Applicable Safety or Occupational Health Regulations, Codes, etc.:
9) Furniture & Specialized Equipment:
• Please list all specialized fixed and/or movable equipment along with furniture. If additional explanatory
information is required (photos, web pages, etc.) please attach them.
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UIS Space Allocation Committee Request Form (University of Illinois at Springfield)

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Completed 29 August 2020

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