Sustainable Fee Request Form
Fiscal Year 2014-2015
To use this form—Tab from block to block—Do not use the return/enter key.
Person making request shall send a printed copy to Carl Gerhold, Chair
and email a copy to sustainfeecommittee@apsu.edu
Name of Requestor:_______________________
Department/Unit:__________________
Project/Request Title:___________________________
Category of Request: Check one
o
o
o
o
Energy and Utilities (electric, gas, water, etc)
Local Generation (Renewables- solar/wind/etc)
Alternative Fuel (hybrid vehicles,bio diesel products etc)
Other (Recycling, Environmental, etc)
Projects/Fee Requests shall:
 Provide or demonstrate a specific energy or environmental benefit
 Be technically and economically feasible.
 Be cost effective to operate and maintain
 Be consistent with campus standards and master plan
Project/Fee Request Description: (Describe what this project will accomplish, be as specific as
possible.) Identify the hardware, software, and physical facilities already available and describe
how they will be used to support/augment this project. In your description estimate the number
of persons (students, faculty, staff, and community) and describe how they will directly benefit.
(maximum 250 words)
List any other requirements, not included in this proposal which are essential to its success: (for
example, HVAC, Lighting, Data ports, Fiber connections, Room remodeling, staffing needs etc)
How does this project address the goals/objectives of the Sustainable Fee Committee?
(maximum 150 words)
One Time Expenditures (round to the nearest $100)
Provide a budget for this project
Item
Qty
Total
Cost per
Total Cost
Name
Signature
Project Manager
_______________________
_________________________
Chair/Director
_______________________
_________________________
Signatures are unnecessary for the emailed copy.
Send a printed copy to Carl Gerhold of Sustainable Fee Committee and email
a copy to sustainfeecommittee@apsu.edu
If you have attachments, please send the attachments with both printed and
emailed forms.