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Space Request Form

1. Department Information
This question requires a valid date format of MM/DD/YYYY.
calendar
This question requires a valid email address.
2. Description of Space Request
What will the space be used for?
If clinical, will the space be licensed to provide hospital services or require other accreditation?
Location
Location
Type
Duration
Who will occupy new space
Are any employees who will occupy the space represented/union positions?
Do any of the planned occupants have known physical disabilities that will require accommodation (e.g., elevator, wheelchair access):
If space is to accommodate a new program or scope of service, do you have an ROI, President’s Council Approval or Business Plan?
If space is to accommodate new hires, have positions been (check all that apply)
Does requesting department have an approved budget or allocation for:
Space Cell YesNoDon't Know
rent
construction
new furniture
IT (cabling, phones, devices)
If request includes private offices, will all private offices be assigned to faculty or director level employee (or higher)
Security Check