Supplemental Resource Planning Request Form
Background and Directions: This form is for annual program planning and is based on a
completed annual or comprehensive program review. If Goals and Plans (or QIPs) in your
program review are either done or ongoing and don’t require additional resources or support,
there is no need to complete this supplemental resource planning request form. This form is
required only if your goals and plans or QIPs require additional resources or support. As with
program review, the resource planning request process is intended to be collaborative. Be sure to
including colleagues in the development of your resource planning request. Complete one form
for each individual plan requiring resources or support. Submit a copy of this completed
Resource Planning Request Form, with any required signatures, to the CPC Support Team.
Title: Provide your own title:
Contact Person(s): include email address and phone number
Planning Request Number: _________ Planning Request numbers will be assigned by the
CPC Support Team.
Description (Tasks, activities, key persons, 100 words or fewer):
CR Strategic Goal(s) and Objective(s) linked to the plan: Be sure to include an
explanation of how your plan will impact these goals/objectives. See CR’s strategic plan with
goals and objectives listed at http://inside.redwoods.edu/StrategicPlanning/strategicplan.asp
Division (Unit) Goal (if applicable)
Departmental Goal
List which of CR’s 9 Key Performance Indicators the plan addresses.
CR’s Key Performance indicators are listed at:
http://inside.redwoods.edu/StrategicPlanning/KPIs.asp
Existing Resources: Indicate existing resources that will be used to carry out this
objective. Indicate “N/A” if this does not apply to your objective.
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Resources from other sources (e.g. instructional grant, matriculation, VTEA, grants, BSI, etc.)
List funds from categorical or other restricted sources. Explain any difference between the
amount needed to complete the QIP and the amount requested or received from another funding
source.
Requested Amount: $
Amount Received: $
Explain the difference between the amounts:
Resources Needed: Additional Personnel. Contact the Human Resources department for a
position title/description and estimated costs before you submit your plan. Indicate “N/A” if this
does not apply.
Position Description:
Estimated Cost: $
Supporting Rationale
Resources Needed: Additional Budget
Description:
Requested Amount: $
Supporting Rationale:
Resources Needed: Additional Technology
Please check any box below that applies:
[ ] smart classroom
[ ] network access
[ ] software upgrades/support
[ ] hardware upgrades/support
Contact the appropriate service provider (ITS/TSS, and/or CR Purchasing Agent) for a cost
estimate before you submit your plan. Indicate “N/A” if this does not apply.
Description of Technology:
Requested Amount: $
What do you want to do or accomplish with this technology?
Where is the physical location that the technology will be installed (Center/site and/or
room number is preferred)?
Is this replacing an existing piece of equipment or is it a new installation?
Resources Needed: Additional Space or Changes to Facilities. Contact Facilities Services
for a cost estimate before you submit your plan. If applicable, attached sketch. Indicate “N/A” if
this does not apply.
Description of Need:
Requested Amount: $
What do you want to accomplish with this space or modification?
Where is the physical location of the space (Center/site and/or room number is
preferred)?
Mark each of the following service(s) you will need if the space is provided:
[ ] electricity
[ ] ventilation
[ ] ADA access [ ] water/sewer
Resources Needed: Other (e.g. policy changes). Please describe:
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Intended QIP Outcomes: Include targets
Evaluation Plan: If you require IR assistance with your evaluation, IR Director signature is
required.
Level of Importance: Please score each of the following on a scale from 1 to 10, where 1 is the
LEAST important and 10 is the MOST important:
How important is this request to the continuation of this discipline/department at its
current level?
LEAST
MOST
1
2
3
4
5
6
7
8
9
10
How important is this request to allowing this discipline/department to
improve/grow/develop?
LEAST
MOST
1
2
3
4
5
6
7
8
9
10
By when do you expect this resource request to be completed?
[ ] immediately
[ ] before the next major term
[ ] in the next academic year
[ ] in the next 2 years
[ ] in the next 3-5 years
Signatures (a signature indicates participation in the development of the plan and agreement
with the plan going forward). Any additional information or comments from signers may be
included as an addendum:
Name
Title:
Department:
Phone:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Supplemental Resource Planning Request Form
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