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(EXAMPLE ONLY) Project Initiation Request
Please print this page, complete Sections A and B, and forward to Facilities Design & Construction, 165 Wilber Hall
A. Requestor Information Date: _____________________________
Requestor’s Name: _______________________ Phone # ___________________________
Department: ____________________________ Campus Address: ____________________
Project Location: _______________________________________________________________
Current Space Use: ___________________________________________________________
Proposed Space Use: ___________________________________________________________
Project Description: (attach sketches if pertinent)
B. Department Dean or VP Concept Approval:
Concept Approval Signature: _______________________________ Date: ____________
Intended Funding Source:
Department Operating Funds Capital Funding (requires PC approval) Other: _________________________
C. Space below for use by Facilities Management
Log # ___________________ Initial: ___________ Date: ____________
Forwarded to: FO&E FD&C Date: ____________
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