Space Request Screening Form University Of Wisconsin Stout

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SPACE REQUEST SCREENING FORM
University of Wisconsin-Stout
Completion of the Space Request Screening Form is phase one in the Space Request Process. The
information supplied in this form enables the Space Allocation Committee to determine whether the
requested space change is feasible and can move to the analysis phase. If approved, phase two of the
process requires the requestor to provide additional detailed information by completing the Space
Request–Short Form for final approval of the space change.
1. Requestor Information
Name:
Date:
Campus Phone:
Campus Email:
College/Unit:
School/Department:
2. Justification
Briefly describe why this space is needed:
Is this space:
New
or
Existing
Select what function the space will serve (check all that apply):
Office
Clinical
Storage
Research
Designated Classroom
Other (describe)
Classroom Laboratory
Gen’l Access Classroom
___________________
Open Laboratory
Other Instructional (describe)
____________________
______________________________________________
How will the use of this space align with UW-Stout’s strategic, capital or unit plan?
Describe why the existing space cannot accommodate this need:
Will existing space be vacated if other space is acquired?
Yes
No
If Yes: A) Location of vacated space:
_______________________________
B) Square footage of vacated space:
_______________________________

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