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Download Microsoft Word Version of the SJD Form
Institute/Center:_______________________________________
Submitting Official (Title) ________________________________
Submitting Official (Name/Signature)_______________________
IC contact name/phone: ________________________________
Date request submitted: ________________________________
Date space needed: ___________________________________
- Project description and scope
- Kind and amount of space requested
Temporary_________
Permanent _________
Kind of Space |
Approximate SF |
Comments |
ADMINISTRATIVE/OFFICE |
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RESEARCH |
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Lab |
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Lab Support |
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Lab Office |
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ANIMAL |
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Procedure |
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Holding |
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CLINICAL |
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In Patient |
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Out Patient |
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SUPPORT |
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- Program Type
EXISTING PROGRAM
Expansion ___________________________________________
Space trade to allow relocation ___________________________
NEW PROGRAM
Temporary or permanent? _______________________________
If Temporary, indicate timeframe ___________________________
Authorizing law or PHS act _______________________________
New IC initiative________________________________________
- Describe program activity (include name and type of functions performed by office/lab/branch):
- If there are specific location requirements (such as a specific building), justify required location and provide detailed description of limitations:
- Programmatic justification for space request
- Explain why space is needed by the requested time and what is impact if it is not available:
- If request is for temporary space during renovation, provide the location of permanent space; the work request number for renovation; and the estimated start date, duration, and completion date of work.
- Explain why the current IC space cannot be used to accommodate the proposed program.
- Staffing
- Provide staffing numbers and positions broken down by organization or function, as appropriate. Indicate temporary, part-time, and other positions. For contract staff, indicate why space cannot be provided as part of the terms of the contract.
- Identify key individuals and attach research summaries as appropriate.
- Provide total number of existing IC staffing in requested building. Justify any change in staffing levels in comparison to latest census figures.
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