GENERAL PURPOSE

This form is to be used to request changes in capital project and departments.  Completed forms are reviewed and processed by the Financial Reporting Office.  Specific questions concerning the completion of this form should be addressed to Jackie Robinson by email or at x87280.

The Action Request for Capital Project/DeptID form is available online as a Word document.   This form is designed to enter data directly into the Word document then print.  You can also save the file if you choose by doing a File/Save As, then name it what you desire.

SPECIFIC INSTRUCTIONS

Information to be completed on the request form:

• Originator  -  Enter the name of the unit's contact person or the individual preparing the form
• Department  -  Enter the department's name
• Phone Extension  -  Enter the telephone extension for the unit's contact person.
• Date  -  Enter the date the form is completed

SECTION I. TYPE OF REQUESTED ACTION

• Requested Action  -  Enter an 'X' to indicate the type of change requested. (Add, Change, or Inactivate)   Enter the effective date for this action in the space provided.

SECTION II. DEPARTMENT INFORMATION

• Department Number
• Short Description
• Manager Name
• Department
• Long Description/Purpose

PROJECT INFORMATION
For all requests, please enter the following:

• Project Description
• Project Manager
• Project ID (project number)
• Project Begin Date
• Project End Date
• Project Amount
• Project Status - check the appropriate box.

SECTION IV. - SIGNATURES –   This form requires Facilities Management authorization.

After completing the form and obtaining the proper approvals, please send the form with a copy of the CO2 form to Jackie Robinson in Financial Reporting, JMAC5, MSC 5715.