APPENDIX NO. 10: SAMPLE FORM - OGSR 3

REQUEST FOR CAMPUS FACILITIES OR SERVICES

I am preparing a grant proposal which, if funded, will require the following campus facilities or services. To assist me in preparing my budget I need to know of any charges that will be associated with these services. Please fill out the bottom section of this form and return to me as soon as possible. If you have further questions, please call me at extension: ____________.

Thank you.

NAME OF FACULTY OR STAFF REQUESTING SERVICES:_______________________________________

NAME OF PROJECT: ___________________________________________________________________

DATE(S) SERVICES REQUIRED: _________________________________________________________

FACILITY OR SERVICE REQUIRED:

[ ] Audio / Video Equipment Reservations	[ ] Photography
[ ] Campus Housing	[ ] Printing Services
[ ] Classroom and Conference Room Scheduling	[ ] P.E. Center
[ ] Computer Services & Communications	[ ] Video / Television
[ ] Food Services	[ ] Wheelwright Auditorium
[ ] Motor Vehicle Reservations	[ ] Other:

Brief description of event or service required:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

CONFIRMATION FOR USE OF FACILITIES AND ESTIMATE OF COSTS

I confirm that the requested facilities are available and approve their use in the above described manner. An estimate of the costs (if applicable) for these facilities or services is provided below for use in your grant proposal:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Signed:

_____________________________________ Cost Center Director / Official

________________ Date

The University will make every effort to reserve these facilities for you at the estimated price, however it is the responsibility of the Principal Investigator to notify, in writing, each service center director if the proposal is funded in order to reconfirm these reservations and costs.