Facilities Form

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A-Z Index

First Name *

Last Name *

Faculty / Service *

Phone *

Email *

Renovation on Existing Space Request

Building

Is the space for the proposed project currently part of the department's / Faculty allocation?

yes

Briefly describe the purpose and need for the project:

Briefly describe the scope of the work required:

Request to Reassign Space

Building (select multiple locations as required)

Room Number(s)

Details of space

Please provide detailed information about what the space is currently used for

Is the space vacant?

yes

If no, please list items left in the space

Items in the space will be considered as surplus to needs and will either be reassigned, recycled or disposed at the cost of the department / Faculty

Reason for this request to reassign space

Please provide a full description of the impact of eliminating the space of the faculty/department

Planning Framework

Is this request valued at more than $2.5 million? *

yes (please go to next question)

If "yes", please complete the following:

Briefly describe the concept/synopsis of the project, including its tie to the Academic Plan, Research Plan, Campus Master Plan and Enrolment Plan

Briefly outline the goals and aspirations of the project

What is the total projected budget estimate for this project?

Will the project result increase operating costs for the Department (s) / Faculty?

yes

If yes please identify the increase cost in sq. m.

Funding Information

Is funding currently available?

no or n/a (skip next question)

yes (please answer the following question)

If "yes" please describe

Department / Faculty

Other (please describe)

Amount $

Account number

Is this request related to a grant submission?

yes

If yes, what is the name/type of grant being applied for? Who is the Primary Investigator?

What is the grant submission deadline?

Month

Day

Year

Timeline

Desired completion date: *

Month

Day

Year

Approved by:

Title:

Signature: (please sign printed copy)

Date

Month

Day

Year

Dean or Equivalent Authorization

Approved by:

Title:

Signature: (please sign printed copy)

Please note: Approval signature do not indicate a guarantee of space allocation for the purpose outlined in this request, nor approval for renovation of existing space to proceed

Month

Day

Year

Confirmation *

I understand that this Space Request Form will NOT be processed until I have also printed out this form and submitted it with the appropriate signatures