Project Request Form
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1PROJECT REQUEST FORM
Project Number_____________________________
(Assigned by Planning, Design & Construction)
All construction, renovations, modifications or changes to existing facilities of Missouri State University requires this
form to be completed before work on the project may begin. The initiating department should complete this form,
obtain the proper signatures, indicate the funding source and submit this form to the Office of Planning, Design &
Construction in the Burgess House.
PROJECT INFORMATION
BUILDING TO BE MODIFIED: ____________________________________________________________________
DEPARTMENT REQUESTING MODIFICATION: ________________________________________________
PROJECT CONTACT: _________________________________
PHONE: ______________________________
Describe overall project request. Identify specific use, room numbers and detail of modifications requested:
PROJECT FUNDING
FUNDING SOURCE: __________________________________ FUNDS AVAILABLE: ______________________
(FOAPAL Required)
FUNDING SOURCE TITLE: ______________________________________________________________________
FOAPAL APPROVER:
_________________________________________________________________
(Print Name)
□
□
Is this project being funded by a grant?
Yes
No
□
□
Will this project be paid for using any federal funds?
Yes
No
APPROVING SIGNATURES
______________________________________
____________________________________
Department Head/Supervisor
Date
______________________________________
____________________________________
Dean/Director
Date
______________________________________
____________________________________
Vice President/Provost
Date
(Required)
At least one signature above must include FOAPAL Approver
Date received in Planning, Design & Construction:________________
REVIEW DATE: Facilities Management:
____________________
ASSIGN TO:
□ Work Management: Date: ____________________ Work Order #: ___________________
□ Planning, Design & Construction
Project Manager: _______________________________
REMARKS:
DATE:
___________________________________________________________________
________________
___________________________________________________________________
________________
01/10/11
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