To be completed by

THE USER UNIT

FUNDING SOURCE

Index #_________________________ Index Title__________________________________

Amount to be transferred to plant fund $__________________________________________

Project Description/Location___________________________________________________

Approval __________________________________________________________________

(User Unit's Fiscal Representative)

To be completed by

FACILITIES PLANNING & CONSTRUCTION/PHYSICAL PLANT

Replacement/Renewal

Capital Improvement

Plant Fund Title_____________________________________________________________

Plant Fund Amount__________________________________________________________

Plant Fund Officer___________________________________________________________

Attachments:

Approved Project Budget Sheet

Duration of Project_______________

Projection Description/Intended Use___________________________________________

Project's Physical Location (Campus, bldg, floor, room)____________________________

Other__________________________________________________________________

To be completed by

UNIVERSITY'S PLANT FUND UNIT

Plant Fund Index #__________________has been established based on the above information.

Approval_______________________________________Date__________________________

(University Plant Fund Manager)

The University is an affirmative action/equal opportunity employer