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Facility Modification Request Form

UVU Facilities Planning
MailStop 155

All proposed modifications to university facilities (buildings, utilities, site work, etc.) must be submitted for approval using this form. Projects will be reviewed and, if approved, designed to ensure compliance with building code and university standards for construction.

Facilities Use Only
Project Number
Project Location
Building Name or Location
Room Number(s)
Project Representative
Department/Title
Name

Required Signatures
Name of Department Head or Director
Name of Dean
Name of Vice President
Manager, Academic Scheduling Office
Signature SIGN HERE Signature SIGN HERE Signature SIGN HERE Signature SIGN HERE

How will this Request impact other departments/divisions, and if so, have you discussed this Request with them?
What semester is this project needed to be complete?
Will the primary use of space be changed due to this request? (Example: changing office to lab). If so, please explain.

Project Justification

Project Description

Index Code #
By completing and signing this form, the applicant consents, as the appropriate budget authority, that the index code(s) indicated on the Request may be used for billing purposes in connection with the project. The applicant also hereby requests that Facilities Planning arrange to have the project completed.

Authorized Signature Name
Signature SIGN HERE

Name of Project Manager That Reviewed Request
Signature SIGN HERE
PM Comments

Additional Comments
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