FMSD Space Request FormForm

1. Request Number: (If this is a multiple-part request, please state which number of total quantity is this request.)

2. Request Date :

MonthDayYear

3. Requestor Name:*

4. Phone #*

E-mail*

5. Division/ College*

6. Department Name*

7. Department Phone Number

8. Check all that apply:

Request for space in unspecified locationRequest for space in specified locationNew ProgramExpansion of an existing programVacating on space to anotherGrant or accreditation relatedWill need funding assistance for space preparation and move

Grant

If this space is to support a grant, please provide the information from the grant application requesting space. Indicate when your grant application is due and when you expect the grant to be awarded. Indicate any funding detailed in the grant to support the space and/or contents of the space.

If this request is for a grant that has been awarded before notification of a need for space, please include the information from the grant application detailing space needs. When will the space needs be required? Indicate any funding detailed in the grant to support the space and/or contents of the space.

9. Grant details

Upload file if necessary below

Grant related file

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Accreditation

If this space is to support accreditation, please provide the information from the accreditation study detailing the space needs. Indicate when your accreditation visit will take place and any funding available to support the space needs.

10. Accreditation details

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Accreditation related file

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Project Information

11. New space requested - Sq. Ft. (if known)

12. Timeline for the requested space. When do you need the requested space for occupancy?

13. When will the space be used? (Regular business hours, after 5 pm, weekends)

14. Proposed use of new space (office, classroom, lab, storage, etc. Include any special needs in the space e.g. sink, storage)*

15. Space Requirements: (Space types and quantities - e.g. 3 offices, 2 general classrooms )

16. Estimated Number of people the space will serve daily:

17. Preferred location if known and provide justification for preferred location: (Building Name and Room Number)

18. Has this request been reviewed with the college/division facilities manager and Dean or Director?

19. Funding Source and Amount Available for Renovation (if department controlled) Grant or Account Number

20. Any special requirements needed (HVAC, acoustics, lighting etc.)?

21. Estimated renovation costs if known:

22. Justifications: (Provide a justification for the requested space with particular emphasis on how it advances the University’s strategic priorities and the programmatic goals and objectives of the department, college and division. If an instructional space, describe the impact on program/university enrollment. Describe the negative impact to program and mission should the request space not become available).

23. Can you share the requested space with other departments? If so, please indicate them. Attach their statement of support (Below). If not, explain why.

24.0Current Space (Describe the current space allocated for the program/project in question)

What space is currently occupied by users:

Campus Name*

Atlanta Campus Building Name*

Alpharetta Campus Building Name*

CHARA Campus Building Name*

Clarkston Campus Building Name*

Decatur Campus Building Name*

Dunwoody Campus Building Name*

Exec MBA Campus Building Name*

Hard Labor Crk Campus Building Name*

Indian Creek Ldg. Campus Building Name*

LRC Campus Building Name*

Newton Campus Building Name*

Panthersville Athl. Ctr. Campus Building Name*

Room Number(s)

Sq. Ft. If Known

25. Vacated space available for reuse (if any):

Please attach any supporting documents below

Attach file with full description (if necessary), (pdf, doc, docx, xls, xlsx format only)

Upload a File

Attach an additional file if necessary

Upload a File

Attach an additional file if necessary

Upload a File

Approval

Vice President or Dean*

VP/Dean Sig Date

MonthDayYear

VP/ Dean Phone #

Space Request Form Instructions

To be completed by Vice President or Dean's Office requesting space

Request For use when submitting multiple space requests
Date: The date form is prepared
Requestor Name: Name of person to be contacted for information related to the project
Phone & E-mail: Requestor's contact information
Division/ College: (e.g., Finance & Administration)
Requestor's department: (e.g., Facilities)
Department Phone Number
Check all that apply to the requested space
Grant: See instructions by the field and attach any grant-related documents to support the request
Accreditation: See instructions by the field and attach any related documents to support the request
New Space Requested: SF-square feet: any needed drawings, dimensions, or room numbers of existing space can be obtained from Facilities Planning, extension 3-0771
Provide a timeline for when the requested space will be needed
What time of day will the space typically be in use (Regular business hours, after 5 pm, weekends)?
Proposed use: Specify intended use, i.e., office, labs, storage, research, classroom, etc., or combination thereof
Space Requirements: Provide information such as the number of offices, cubicles, and other support functions
(storage), and special equipment needs (computer wiring, wireless, projectors, screens, etc.) Provide the number of staff, faculty, and/or students to occupy this space. If desired space has been identified, describe any changes or modifications required to make it serve your needs.
Define the number of occupants the space will serve daily.
Preferred location: Building and room numbers if existing space has been identified
Has this request been reviewed with the college/division facilities manager and Dean or Director?
Funding Source and Amount Available for Renovation (if department controlled) Grant or Account Number
List any special requirements needed (HVAC, acoustics, lighting, etc.)?
Provide an estimate of renovation cost if known
Justification: Indicate if the requested space is for a new program or to expand an existing program. Provide a justification for the requested area with particular emphasis on how it advances the University’s Strategic Plan and the programmatic goals and objectives of the department, college, and division. This justification will be used to evaluate the request's merit and to rate it against competing requests. Describe the negative impact on the program and mission should the requested space not become available.
Can you share the requested space with other departments? If so, please indicate them. Attach their statement of support (Below). If not, explain why.
Current space: Identify current space used for purposes proposed for new space, including building, rooms, and square footage. Use the main field to describe the current space and dropdown fields to identify the exact location on the GSU campuses, including room numbers and square footage if known.
Vacated space: If space is vacated when moving to a newly assigned area, please indicate the building, room numbers, and approximate total sq. ft.
Attach any related files for justifying the request that has not already been provided above.
Signature block: Authorization of the request for space by the Vice President or Dean.

This completed request form will be forwarded to
Facilities Space Management at:
FMDSpace@gsu.edu