School/Unit:
A&S College of Arts and Sciences KNT Kent School of Social Work SC Service Center COB College of Business and Public Administration DTL School of Dentistry ED College of Education and Human Development GRD Graduate School RES Exec VP for Research (EVPR) LAW Brandeis School of Law PH School of Public Health MED School of Medicine MUS School of Music NUR School of Nursing UGA Undergraduate Affairs SPD Speed Scientific School ASP Academic Support Units OAP Other Academic Programs LIB Libraries PP Physical Plant IS1 President's Office IS2 Provost's Office IS3 VP Business Affairs IS4 VP Information Technology IS5 VP University Advancement IS6 VP External Affairs IS7 VP Finance EVPHA EVP Health Affairs RVS Central University Reserves SA Student Affairs EMO Enrollment Mgmt Office SGA Student Government Association AID Student Financial Aid ATH VP Athletics AUX Auxiliary Enterprises HSG University Housing HOS Hospital MC Metropolitan College GIE General Insitutional Expense TR Mandatory Transfers

Department Name:

Department Number:

Date:

This request is for:
New/Additional Space Assignment
Renovation of Space
Purchase and Installation of Specialized Equipment and/or Furniture

Will this request for additional space or renovation require special accomodation to provide for accessibility or other needs for the physically disabled? Yes No

I. New/Additional Space Assignment (skip if not applicable)

1. Identify the area requested for new/additional space:
Building Name
Room Number (s)

2. For what purpose is the requested area currently used?

3. Describe the purpose (i.e. lab, classroom, office, etc.) for which the new/additional space will be used. Include room numbers if possible.

4. What date would you need the new/additional space?
Earliest Date:
Latest Date:

5. What will the consequences be if this request is not approved?

II. Renovation of Space (skip if not applicable)

1. Identify the area requested for renovation:
Building Name
Room Number (s)

2. For what purpose is the requested area currently used?

3. Provide a brief description of the renovation requested.

4. Describe the purpose (i.e. lab, classroom, office, etc.) for which the additional space will be used. Include room numbers if possible.

5. What date would you need the renovation completed?
Earliest Date:
Latest Date:

6. If you intend to ask Central Administration for any of the renovation costs, please indicate the desired amount.

7. Indicate the amount of funds your unit/department can provide for the renovation.
Amount
Speedtype

8. What will the consequences be if this request is not approved?

III. Purchase and Installation of Specialized Equipment and/or Furniture (skip if not applicable)
(Note: Individual items of equipment with a value greater than $100,000 requires special budget authorization or grant support.)

1. Identify the location requested for the equipment/furniture:
Building Name
Room Number (s)

2. Describe the equipment/furniture and explain the purpose for which it will be used.

3. Describe the special requirements and/or utilities necessary for installation and operation of the requested equipment.

4. Can specific manufacturer installation requirements be provided upon request?
Yes No

5. Has the equipment/furniture already been purchased?
Yes No

6. What date would you need the equipment/furniture installed?
Earliest Date:
Latest Date:

7. If you intend to ask Central Administration for any of the equipment/furniture costs, please indicate the desired amount:

8. Indicate the amount of funds your unit/department can provide for the equipment/furniture:
Amount
Speedtype

9. What will the consequences be if this request is not approved?

Additional comments

If you are a Dean/Vice President, please send this request to the UPDC Service Account by entering updc@louisville.edu in the "Submit to" field. If you need prior approval from your Dean/Vice President before submitting this form, please enter the email address of the approver in the "Submit to" field.

Submit to (enter email address of approver)

Submitted by

E-mail address

Phone