Binghamton University Space Request Form
Innovative Technologies Complex Biotechnology Building
Revised
9/4/08
This form should be used to request space in the Innovative Technologies Complex (ITC)
Biotechnology Building. The individual researcher or research group leader requesting this space
should complete this form. Completed forms should be sent to the ITC building manager.
Please type or print neatly
Section I
DATE:____________________
A. Contact Information
Please provide the following information about the individual requesting the space.
Name
Ext.
Address
E-Mail
Names of additional researchers for a research group
B. Funding Sources
Please indicate amount and source of funds available for any costs associated with allocation of
space. This would include moving expenses, equipment installation and general renovation
costs.
C. Grant Information
To assist in the review of your request and establish appropriate allocation of space,
please provide the following:
Grant Sponsor Name Status-Applied/Awarded
Date of Funding
Project Director
Please attach a copy of the proposal approval form for each of the above listed grants. If you do not have
these forms they can be obtained from the Research Division.
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Binghamton University Space Request Form
Innovative Technologies Complex Biotechnology Building
Revised
9/4/08
Section II
.
Check the one that most closely describes how space will be used:
Research space (How much space needed in sq. ft.) ...............................................
Office space (How many offices needed?) ........................................................
Other, please explain (e.g. access to core facility) ...................................................
Space will be primarily used by:
Faculty
Post Docs
Staff
Research Staff
GA's
External Constituents
Number of Occupants Ranges From To
Date space is needed:
Length of time needed
(months/years)
A. Description of Space Use
Please indicate the time period the space will be in use for each time frame.
(Indicate a.m./ p.m.)
B. Space Utilization
Monday
Tuesday
Wednesday Thursday
Friday
Saturday
Sunday
Fall
Spring
Summer
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Binghamton University Space Request Form
Innovative Technologies Complex Biotechnology Building
Revised
9/4/08
C. Staffing
Name(s) of person(s) who will be using the space:
Hrs/wk
Name
Title
Status
Account
Using
Existing
To Be Hired
Existing
To Be Hired
Existing
To Be Hired
Existing
To Be Hired
Please indicate utilities required within:
Electric-120v
Gas
Computer/Data
Electric-220v
Cable TV
Telephone
Emergency Power
Water
Air Conditioning
Other
Please check all features required:
Fume Hood
Dry Lab
Wet Lab
High Bay
Special Lighting
Other
_____________________________________________________________________________
Please list the types and quantity of equipment/furniture to be housed within:
Quantity
Description
Size (L x W x H)
Existing
To Be Purchased
Existing
To Be Purchased
Existing
To Be Purchased
D. Equipment/Furniture
E. Special Requirements
Please describe any other requirements of this space including its proximity to other facilities.
Indicate any space that is particularly suited to this request.
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Binghamton University Space Request Form
Innovative Technologies Complex Biotechnology Building
Revised
9/4/08
Section III
Description of the Research Activity
·
Describe the activity to be undertaken in the ITC and how it supports research in the area
of life sciences or enabling technologies. Outline the potential economic impact of the
research and how the research complements activities at the ITC.
·
Indicate space that will be relinquished if ITC space is allocated
·
Attach to back of form.
Section IV
Approvals
By signing this request, the researcher agrees that the information contained herein is correct and that
fulfillment of this request would advance the ITC goals. Only requests with appropriate approval
signatures will be considered for space allocation.
Researcher requesting space
Date
ITC Building manager
Date
Vice President for Research
Date
Comments:
·
Obtain information for all spaces allocated to the researcher on the current Physical
Space Inventory (PSI) by calling 7-2365
·
Verify that existing PSI information is correct or indicate necessary changes.
______________________________________________________________________________________
For ITC management committee
Priority H M L
ITC management committee Recommendation:
______________________________________________________________________________________
For ITC building manager use only
Space Request Number:
Date Received:
Notification Date:
Renewal Date:
Space Assigned, if applicable:
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Document Outline