FPPO Use Only:
 Space Move
 Space Renovation
FACULTY/STAFF PERMANENT SPACE REASSIGNMENT
REQUEST FORM
Note: Requests for student space needs to come from appropriate division administrator.
SECTION I – Request for Room/Space (Track-It Work Order must be submitted in addition to this form)
Date of Request: ____________________
Building / Facility: ____________________________
Work Order #:____________
Room: ___________
Date(s) of Room/Space Needed: ________________________________________
Reason: _____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
Who currently owns/occupies the space?: ___________________________________________________________________________________________
Requesting Department: _________________________________
Requestor Name:___________________________________
Ext. __________
Requestor:
Approval to Request Estimate:
Requestor Signature
Date
Requesting Program Chair/Dean & Manager
Date
__________________________________________________________________
Requesting Non-Instructional Manager
Date
Requestor to Complete Section I submit to Program Chair/Dean
SECTION II – FP&PO Review
Comment/Potential Work Needed: ________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
Estimated Total Project Cost:
Estimate Effective Until: _____________________ Estimated Project Duration: ____________________
$
IT Needs/Cost/Timeline: ___________________________________________________________________________________________________
Required Approvals: (all checked boxes require approval in sections III and IV in order to proceed)
Requesting Division
Facilities & Planning Committee
Board
Cabinet
FP&PO Approval:
CPC
FP&PO Approval:
Help Desk Signature
Date
Director of FP&PO Signature
Date
FP&PO to Complete Section II and Forward to the Requesting Administrator for Approval
SECTION III –Requesting Division to Cabinet for Review
Are funds available to support this project?
Yes Budget #
No
Funding Available: $
Astra changes as a result of this project?:_______________________________________________________
Acknowledgement of Cost (as per Section II above):
Requesting Dept. Administrator Signature
Date
SECTION IV –Required Approval
Board Approval Date: ______________
Cabinet Approval Date: _____________
CPC Approval Date: ______________
(If Required)
Return to FPPO to authorize work or to requesting department with explanation of denial.