Non UMC Project Request Form

This form is to be used if you seek assistance from POC on a project that does not require UMC review and approval pursuant to the University’s Facility and Space Modification Policy.

Project Contact Person:

Department and Location:

Date of Request:

Phone Ext.

Project Description:

Reason for the Request:

Desired Date of Completion:

Please allow a few weeks for your desired completion date due to our feasibility check process.

Approved Funding Amount:

YesNo

Enter Amount:

Do you have an approved Funding Source/Chart String?

YesNo

Enter Chart String Information:

Requester:

Approved By:

Title:

Any additional comments or considerations:

In order to help you in the most efficient way possible, please provide as many photos as you feel are relevant to your request

File Upload (please attach photos or sketches if helpful):

Pepperdine's communication and GDPR Privacy Notice.

Yes, I agree

* The Chart String will not be charged until final requester approval is obtained.