New Facility Modification Request (FMR)

FMR Number:

Facilities Department Use Only

Date Sent to VP

Facilities Department Use Only

Returned to FCS

Facilities Department Use Only

Assigned to Unit

Facilities Department Use Only

Please Leave the FMR Number, Date Sent to VP, Returned to FCS, and the Assigned Unit fields above Blank. They are intended for Facilities use only.

If any of these fields have entries you will NOT be able to Submit this form.

Part 1. Instructions

Within two (2) days after receipt of this form, the Facilities Customer Service Center (FCSC) will notify the contact person by email of the FMR number. Facilities will evaluate the request to determine if:

the request requires Capital Planning and Space Allocation Committee (CPSAC) approval. Facilities in conjunction with the requesting unit will develop the documentation for submission to CPSAC.
the request is for a research facility and requires approval by the Vice-President for Research. Facilities in conjunction with the requesting unit will develop the documentation for submission to the Vice-President for Research.
the request is eligible for cost estimating by the assigned department (Renovation, Design & Construction and maintenance). The assigned department receives the request, the contact person will be notified and asked to meet to discuss the details of the project. Once the project has been estimated and the contact person notified, he/she should:
1. approve the estimate by notifying the Estimator with approved account number; OR;
2. revise the scope of work and resubmit the request to the assigned Estimator; OR:
3. cancel the request and inform the assigned department and the FCSC.
  The contact person will receive periodic updates from the Estimator on the status of the request.

Part 2. Client/Contact Information

Contact Name *

Department *

E-mail *

Phone # *

Part 3. Location & Description of Request

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 *

Lakeside Campus Building Name *

LRC Campus Building Name *

Newton Campus Building Name *

Panthersville Athl. Ctr. Campus Building Name *

Room Number(s)

Description of Work: (Attach additional file below if needed) *

Attach up to 2 files with full description (if necessary), (pdf, doc, docx, xls, xlsx, jpg format only) File size limited to 5MB

second file

Part 4. Budget
Please provide an account number
if you would like the work request
to proceed as long as the cost does
not exceed the budget.

Budget is restricted to a cost not to exceed:

Speed Type

Part 5. Approvals

Signature *

Signature Date *

- Month - Day Year

Director/ Dean/ VP Signature

Director/ Dean/ VP Signature Date

- Month - Day Year