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Form Instructions:

  1. That all fields must be completed in order to submit this form. If you have any questions regarding the form itself, please contact Michelle Watts at extension 1991.

  2. The Facilities Management: University Architect, Design & Construction Department will not proceed with a project without a written request detailing the scope of work and verification of budget. If you need an estimate to determine budget, complete the form and check box next to "Project Estimate Requested."

SECTION I: CONTACT INFORMATION

Person Requesting Service:  

Phone:                                  

Department:                          

SECTION II: PROJECT CONTACT INFORMATION

Project Contact:        Title:  

Email Address:       Phone:  

Department:       Department Phone:  

Bldg:  

SECTION III: BUDGET INFORMATION

Budget Amount:   Budget Account #:  

Budget Unit Administrator: Project Estimate Requested:  

SECTION IV: SCHEDULE REQUIREMENTS

Required Project Start Date:            

Required Project Completion Date:  

Space Availability Issues - Specify:   

SECTION V: SCOPE OF SERVICES

New Walls

New Door(s) – Type: Room #(s):

Remove Door(s) - # of Doors:

New Electric - Specify:

New Data:

  • Specify number of data drops needed:
  • Specify type of equipment to be used (i.e., fax, computer, etc.):

New Furniture - Specify type:

Paint – Room(s):

Other - Explain Below

Relocate Existing Furniture from: to

Total Renovation - Specify Room(s) (#):

SECTION VI: WRITTEN EXPLANATION OF SCOPE

Instructions - Describe in short detail what the scope of work will be, including a description of the service you are requesting. This includes: interior and/or exterior building: modifications, furnishings, finishes, signage, lighting, window treatments, floor finishes, etc, that will change the space. Please note any changes to building modifications that include: room function changes, size, along with addition or demolition of walls, doors, etc., must be approved by Campus Planning. You may send a copy of this request for approval to Mary Paula Schuh at: schuh@nku.edu.

SECTION VII: INTERNAL OFFICE USE ONLY (Do not complete form below this point)

Project Assignment: (circle one): CH MH MS RK SN

Project Number: - -

Date Assigned: / /

2007 Northern Kentucky University

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