Facilities Modification Request Application
No.
The Facilities Modification Request Application is designed to assist in the development of your facilities
modification idea and provide college leadership the information needed to review the request. It is
highly recommended that your application is prepared when your request is in the concept phase. When
the application is complete, the Dean or Manager will submit the application to the college leadership
for review by the President’s Cabinet. You may be asked to provide additional information. When/if the
Cabinet approves your Facilities Modification Request Application, your project may move from the
concept stage to the development stage.
This application is intended for projects that are not routine Work Orders
and are not part of the Division’s Area Plan
CONCEPT DETAIL
The purpose of this application is to inform the campus of your proposed project and ensure that all
financial and operational needs of the project can be met by the District. This application will be
presented at President’s Cabinet for approval. Only with Cabinet’s approval can you begin the
development or begin the project.
General Information
Project Title:
Project Description:
Describe Project that you are proposing (attached additional pages or information as needed):
Funding:
Has a funding source been identified for this project? Yes 
Identify source:
No 
Are there funding deadlines associated with this project? Yes  No  If so, provide the information
below:
Proposal Deadline:
Total Request: $
Partner Organizations:
Requested Submitted By:
Division Name:
Project Leaders: Director/Coordinator
Other Team Members:
1
Extension:
Email:
Extension:
Extension:
Extension:
Extension:
Email:
Email:
Email:
Email:
Facilities Modification Request Application
No.
College Implications
Explain how the project relates to college goals and/or your division’s plan.
Impact on Campus
Will this project have an impact on other Divisions? If so, please explain the impact and if the impact is
positive or negative.
On-Going Maintenance
Will this project increase service needs by the college? (eg: custodial, grounds, maintenance)
Equipment
List the equipment the college will need to provide for this project.
Division/Approval Process
Comments/Recommendations:
Division Dean:
Division Vice President:
Date
Date
The Director of Facilities Services will submit the form for Cabinet approval. The four signatures below
signify Cabinet approval and must be received in order to submit a grant to any funding agency.
President:
Vice President, Academic Affairs:
Interim VP, Finance & Business
VP, Student Services
Date
Date
Date
Date
2