INSTRUCTIONS: Complete this form to request support for the repair or service of electromechanical equipment; refrigeration equipment; design and fabrication of wood, plastic, or resin items; small / major renovations or remodels of existing facilities; construction of new structures; etc. Priorities will be based on the date this Work Request is received, your request date of completion, intended function of the finished product, and length of time required to complete the project. Please fill out as completely as possible.

CONTACT INFORMATION
Name
Phone Number
E-Mail Address
Mail Code

JOB INFORMATION
Requested For
Department/Program
Location/Room Number
Date of Request
Desired Completion Date

NATURE OF REQUEST
Please Select One Repairs/Maintainence: Electromechanical or Refrigeration Equipment on/off Campus Repairs/Maintainence: Field Station/Off-Campus Facilities Repairs/Maintainence/Rigging: Boat or Engine Service Furniture Construction: Office/Lab Custom Fabrication Other Work not Listed
If fabrication is required, what materials will be needed? Plastic/Resin      Wood      Metal

PROJECT TIME ESTIMATE
Please Select Time Don't Know 1 Hour or Less 1 to 4 Hours Greater than 4 Hours

SOURCE OF FUNDING FOR THE REQUIRED MATERIALS
Please Select One Account Cash Credit Card Providing own Materials Other   Account Number

PROJECT DESCRIPTION (Include materials, supplies, or help that you are providing)


PROJECT OBJECTIVE/JUSTIFICATION (If emergency or high priority, please explain)