Storage Request Form

Date: ___________________

Requesting Department: ___________________

Contact Person: ___________________

Phone/Extension: ___________________

Date Required: ___________________

Amount of space required (approximate): ___________________

Building/Area preferred: ___________________

Specific requirements, i.e. (chemicals, flammable, controlled access, etc.):

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Reason for storage:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Description of item:

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Authorized Signatures:

___________________

Division Chairperson

___________________

Vice-President of Instruction or Students

___________________

Vice-President of Business Services

___________________

President