SPACE AND INFRASTRUCTURE APPLICATION FORM

Completion of the Space or Infrastructure Application is phase one of the Space or Infrastructure Request Process. The information supplied in this form enables the Space Management Department to register the application. Detail space requirements will be obtained during the project investigation phase.

SECTION A: Details of the Faculty or Support Department submitting the application
Faculty / Support Department:
School / Division:
OE Code:
Name and Surname of Applicant:
Contact number:
Email address:
For Faculty only:
Subject group:	Number of registered students:

SECTION B: Project type and funding
Scheduled / Unscheduled Project: (with reference to the below definitions, please indicate type of project)

☐ SCHEDULED

Shall mean the development of new infrastructure and/or the re-development of existing infrastructure and/or additions to existing infrastructure, where the project has been approved by Council in accordance with the annual budget process

☐ UNSCHEDULED

Shall mean the development of the new infrastructure and/or the re-development of existing infrastructure and/or additions to existing infrastructure, where the application for the approval of such project is not presented as part of the annual budget process (i.e. external-funded)

Project type and source of funding

(with reference to the below definitions, please indicate type of project)

☐ CAPITAL PROJECT

Shall mean the development of new infrastructure and/or the re-development of existing infrastructure and/or additions to existing infrastructure with an estimated project value of more than R2 000 000.00

☐ MINOR BUILDING WORKS PROJECT

Shall mean the development of new infrastructure and/or the re-development of existing infrastructure, where the total project cost of the project does not exceed R2 000 000.00 rand in value.

☐ CAPITAL RENEWAL PROJECT

This is capital renewal of an existing building which requires capital upgrade to be made fit for purpose again

☐ 3rd STREAM INCOME RESERVE / OTHER FUNDING

This shall mean the funding for the project shall be provided by either special donor/departmental budget etc

SECTION C: Project / Request Description and Rationale and motivation
Please provide a short overview with a clear description of the facility required, the need and purpose thereof. Also indicate the shortfall it seeks to address, the anticipated users, possible alternative solutions that have been considered and the long term growth and sustainability

SECTION D: Planning and Policy alignment
Project Requirements	Comments
Which / what university objectives does the project support or promote?
How does the project support key academic, administrative, residential or student -life functions and activities? (If an academic program – please provide details) If an activity – please provide details)
Is the Project Supported by a Policy / Regulations? Please identify the relevant university policy and highlight the section/clause that support the project application
Is the Project in Line with the Annual Performance Plan? Please insert the relevant reference in the APP.
Demonstrate how the project is in alignment with the university’s academic plan, enrolment plan and growth projections.
Is the Project / Activity Currently operational?
If yes, indicate which is applicable The facility has already been operating but (1) in limited, (2) non-compliant or (3) compromising circumstances
What problem has given rise to the need for additional /refurbishment / upgrade of infrastructure
What is the urgency of the need to be met
What would the impact be if the application is not approved
Is the request a result of OHS inspection /audit?

SECTION E : Space requirements and DHET Classification
No of Student FTE’s to make use of space(s)
No of Staff FTE’s to make use of space(s)
Program/ Module codes relevant to application (for academic activities)
Classification of Educational Subject Material (CESM)
Primary space requirements – please indicate what is required
Space code	Space category	Quantity	Capacity	Comments on space needs
1100	Classroom Facilities
1200	Laboratories Facilities
1300	Office Facilities
1400	Study Facilities
1500	Special use Facilities
1600	General Use Facilities
1700	Sport Facilities
1800	Health Care Facilities
1900	Residential Facilities
Secondary space requirements
Space code	Space category	Quantity	Capacity	Comments on space needs
1315	Cloakrooms
1315	Kitchen
1600	Recreation area
Other (short description)

SECTION F: Fixed equipment required (Details of Infrastructure fixed equipment required)
Building number	Space Number
Equipment request	Comments	Equipment request	Comments
Aircon	7. Lift
Gas	8. Fume Cabinet
Laminar Flow cabinet	9. Bio safety system
Electrical supply or distribution	10. Fencing
Landscaping	11. Parking / covered parking
Water supply or distribution	12. Open space
Description of infrastructure / equipment required

SECTION G: Signature / recommendation and approval
Applicant (Director level or higher)
Name and Surname:
Date:
Signature:

Executive Dean / Chief Director
Name and Surname:
Date:
Signature:

Prioritisation of application by Executive Dean / Director of relevant Faculty / Support Department

☐ A – of highest strategic

☐ B – of strategic value but can be postponed

☐ C – not recommended