Revised: September 03, 2019

Space Change Form FACILITIES & CONSTRUCTION

(for F&C use only)

___________ _____________ ___________ Academic Non-Academic UTMC

Space Change Number: ___________ Date Initiated: __________ Date Received by F&C: _________

Part I of this form is to be completed any time there is a Request for Space (a request for additional or different space without specific space identified); Part II is to be completed for a Request for Change in Occupancy (the department assignment of a room changes); Part III is to be completed for a Request for Change in Room Use.

Approvals: • Approval from both Director/Dept. Chair and Dean/VP required for all requests.• Academic Space Approval - If space change involves academic space, approval required from Provost and Executive VP for Academic Affairs.• Non-Academic Space Approval - If space change involves non-academic space, approval required from Executive VP for Finance and Administration.• UTMC Space Approval - If space change involves space at the UT Medical Center, approval required from Executive VP for Clinical Affairs.• Approval from two or more Executive VP’s may be required for requests involving a combination of academic, non-academic and/or UTMC space.

Note: If renovations are necessary, initiate a Capital Project Request form after Space Change Form is approved.

Digital Signature Required: This document is designed to be signed digitally. For digital signature instructions, please click HERE FOR TUTORIAL.

I. REQUEST FOR SPACE (Attach additional sheets if necessary) When Part I has been completed (with signatures) forward to Dan Klett Type of Space Requested: _____________________________________________________________________________________________________ Size of Space Requested (SF, # of Occupants, etc.): ________________________________________________________________________________ Suggested Location: _______________________________ Responsible Account (Index #): _____________ Describe Need: ______________________________________________________________________________________________________________ Reasons Space is Needed: ____________________________________________________________________________________________________ Anticipated Date of Need: _______________________________ Typical Hours of Operation: _______________________________ Current Space (If any): Campus: _____________ Building: _____________ Floor: _____________ Room(s): _____________

Authorized by: ________________________ Date: _____________ Authorized by: ________________________ Date: _____________ Signature 1 (Director/Dept. Chair) Signature 2 (VP/Dean)

II. REQUEST FOR CHANGE IN OCCUPANCY When Part II has been completed (with signatures) forward to Dan Klett Campus: _____________ Building: _____________ Floor: _____________ Room(s): _____________ Room Presently Assigned To: Faculty/Staff Member: _______________________________ Phone #: ____________________ Department: _______________________________ Responsible Account (Index #): _____________ Anticipated date to move out: _______________________________ Is relocation plan complete? Yes _ No _

Authorized by: ________________________ Date: _____________ Authorized by: ________________________ Date: _____________ Signature 3 (Director/Dept. Chair) Signature 4 (VP/Dean)

Room Being Reassigned To: Faculty/Staff Member: _______________________________ Phone #: ____________________ Department: _______________________________ Responsible Account (Index #): _____________ Anticipated date to move in: _______________________________

Authorized by: ________________________ Date: _____________ Authorized by: ________________________ Date: _____________ Signature 5 (Director/Dept. Chair) Signature 6 (VP/Dean)

III. REQUEST FOR CHANGE IN ROOM USE When Part III has been completed (with signatures) forward to Dan Klett Campus: _____________ Building: _____________ Floor: _____________ Room(s): _____________ Present Use of Room (Please check): Office _ Instructional Lab _ Research Lab _

Patient Room _ Clinical Space _ Conference Room _ Other _ (Specify): _________ New Use of Room (Please check): Office _ Instructional Lab _ Research Lab _

Patient Room _ Clinical Space _ Conference Room _ Other _ (Specify): _________ Anticipated date of change: _____________

Authorized by: ________________________ Date: _____________ Authorized by: ________________________ Date: _____________ Signature 7 (Director/Dept. Chair) Signature 8 (VP/Dean) ACADEMIC SPACE APPROVAL

Authorized by: ________________________ Date: _____________ Signature 9 (Interim Provost & Executive VP for Academic Affairs: Karen Bjorkmam, Ph.D.) (for F&C use only) NON-ACADEMIC SPACE APPROVAL _______________ _______________ _______________

Authorized by: ________________________ Date: _____________ Form Initiated by F&C Approvals Required Authorized by

Signature 10 (Interim Executive VP for Finance and Administration: Matt Schroeder) UTMC SPACE APPROVAL _____ _____ _____ _____ _____

Authorized by: ________________________ Date: _____________ Floor Plan Data Table GIS Tracking Approval Email

Signature 11 (Executive VP for Clinical Affairs: Christopher J. Cooper, M.D.)

Setting up a Digital Signature in Adobe Reader or Adobe Acrobat

Digital Signatures

A digital signature is an electronic version of a hand written signature. In order to be able to

electronically sign documents, you must first set up a digital ID. Once you complete the digital ID

set up process, you are ready to begin signing documents electronically.

The exact language used varies slightly for each Adobe version, but the basic set up process is the

same.

STEP 1

Open the document you want to sign and click on the appropriate signature field.

STEP 2

Select “A new digital ID I want to create now” (exact wording varies for each Adobe version). Click

“Next”.

Digital Signatures

STEP 3

Specify where to store the digital ID. Select “New PKCS#12 digital ID file (PDCS#12 is more secure

since it requires you to enter your password each time you digitally sign a document). Click “Next”.

STEP 4

Type your personal information (name, organization unit, organization name and email address).

Leave all other settings as they are. Click “Next”.

Digital Signatures

STEP 5

Enter a file location and password for your new ID file. Either use the default file location or enter a

different location if you prefer. Create and enter password into both password fields. Click “Finish”.

STEP 6

You are now ready to sign the document. Click on the signature field where you want to sign.

When the “Sign Document” signature pops us, select your digital ID from the “Sign As” dropdown

menu and enter your password.

IMPORTANT: In order for your

digital signature to take effect, you

MUST save the file.

Do Not Check