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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
    RESEARCH
    Lab
    Lab Support
    Lab Office
    ANIMAL
    Procedure
    Holding
    CLINICAL
    In Patient
    Out Patient
    SUPPORT

    
    
    
  • 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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