ࡱ> ~ bjbj w~#$P_DT7%7'7'7'7'7'7'7d9<'7'7<7X%7%71s3@(N@td'27R707=26<<,s3s3&<3x0"$@'7'7b^7< : Request for Space, Request for Alteration, Request for Alteration Funds, or Request for Change in Primary Function of Space èƵ ATTACH ADDITIONAL PAGES IF NECESSARY I. CONTACT INFORMATION:Requesting Department:Date:Name:Phone:Email:II. DESCRIPTION OF DEPARTMENT: (complete B, C, D, and E if requesting additional space)Briefly describe the function of your department. Number of full-time faculty ______, Number of part-time faculty _____, Number of staff _____, Number of student workers _____Do you anticipate the number of people in your department increasing within the next two years? Yes ( No (If yes, indicate anticipated growth: Number of full-time faculty ______, Number of part-time faculty _____, Number of staff _____, Number of student workers _____ How much space do you currently have? (total assignable square feet) III. REQUEST FOR SPACE: If you need assistance completing this form call Tim L. Nelson at 786-4902 or by email at antln@uaa.alaska.edu. If you need copies of floor plans, they are available on our website at http://fpgis.uaa.alaska.edu/CampusBuildings.htm.Briefly describe why new/additional space is needed. Address the implications to your program/service if additional space is not approved. (You may attach drawings/floor programs/diagrams): New space will be used for: Instruction ( Research/Grant ( Administration ( Storage ( Support ( Other, please specifySpace will be used by: Faculty ( Staff ( RA/TA ( Students ( Other, please specifyWhat 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? Have you identified a suitable location for this new space that may be available?Yes ( No (If yes, describe, identify building/room #s or attach drawing/floor plans/diagrams: (If No, please proceed to line K.) Have you contacted current holder of the space provided? Yes ( No (Do they support the concept? Yes ( No (Date Needed Provide information on any time constraints that may affect the timing of allocation of the space. IV. REQUEST FOR ALTERATION OF SPACE:Alteration of current space needed? Yes ( No (Alteration needed of new space requested?Yes ( No (If yes for A or B, briefly describe these changes and any special requirements (e.g., service requirements/loading dock, plumbing, electrical, etc.) for this space including the need for proximity to other facilities.  V. REQUEST FOR FUNDING FOR ALTERATION OF SPACE:Do you have funding available for project? Yes ( No ( Total amount available: If funds are available, please identify source.VI. REQUEST TO CHANGE FUNCTION OF SPACE: (if more than one room is involved, attach additional page)Room # ________ Current Room Type _____ (for help with room type codes, please contact Tim L Nelson at 786-4902 or antln@uaa.alaska.edu) Requested Room Type Change _____ Justification for change:  REQUEST AUTHORIZATION SIGNATURES (the signatures below indicate agreement that the space request should be investigated. Approval to proceed does not indicate a guarantee of space for the purpose outlined in this request.)Department Chair or Director:Date:Comments:Dean/Assoc or Assoc. VC:Date:Comments:Provost/Vice Chancellor:Date:Comments: Forward by inter-campus mail or fax, this completed form with the proper signatures and the required plans to the Office of Space Management Attn.: Tim L Nelson (ULB 110 I). FAX number: FPC ( 786-4901). OFFICE OF SPACE MANAGEMENT ACTIONDate Space Request received: Date Plans received:Date Space Assessment completed:Date additional information requested:Date OSM forwards space assessment, completed form and plans to the PBAC-FC:  PBAC- FACILITIES COMMITTEE ACTIONDate reviewed by Committee:Action taken by committee:Less than $25,000 & Dept. 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