Preview Budget Request Form

Detailed Capital Budget Request Form

(To be completed for all individual expenditures/projects > $25,000 in accordance with the Capital Expenditure Policy)

1. Project Details

Project Name:

Life (years):

Completion Date:

Project Originator (Name):

2. Project Description/Justification Include a detailed description of the project and justification. Attach addt'l documentation as necessary.

Date Submitted:

Department:

Desired project timing: Start Date:

Phone:

Location:

3. Project Cost Estimate Attach detailed breakdown of costs. If the project relates to construction/remodeling, please attach a Facilities

Department Cost Estimate.

YES

Included in Fiscal Year Budget:

Amount: $

Total Project Cost: $

Project Cost Estimate:

Amount $

Total $

Timing of Project Costs

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