Schedule Request Form

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					     CREIGHTON UNIVERSITY                                                                                                                                            SCHEDULE H
     CAPITAL EXPENDITURE REQUEST FORM (Required for Every Capital Asset Requested of $50,000 or more)
     (Instructions & further information may be found in various places on the form at the red triangles)

     SCHOOL OR ADMIN. DEPT. NAME:                                                                              SIGNATURE OF SUBMITTING VICE PRESIDENT :

                                                                                                               CONTACT PERSON (NAME/NUMBER):
     I.   DESCRIPTION & JUSTIFICATION OF CAPITAL REQUEST:
          A1. Project Name & Brief Description below:



          A2. (Provide a "justification" for this request below (attach a separate page if necessary):




          B. Type of Capital Asset (Check one of the following:                                             C.Tie Request to Specific University
                  New Construction                                                                           Strategic Plan Issue and Goal and enter number below:
                              or
                  Renovation Replacement/Renewal
                  Building Acquisition                                                                                         NOT REQUIRED
                  Major Equipment Purchase
                  Major System

          D. Complete for New Construction , Renovation/Renewal &
            Building Acquisition Only:
                Site preparation requirements (Y/N?)                                                   If "Yes", Give Brief Description:
                  Prelim. Study Done by Others (Y/N?)                                                  If "Yes", Give Brief Description:
                  Architect Needed (Y/N?)                                                              If "Yes", Give Brief Description:
                  Mandated by Outside Agency (Y/N?)                                                    If "Yes", Give Brief Description:
                  Square Footage
                  Space Assigned (Y/N?)                                                                If "Yes", Give Brief Description:
                  Lease or Purchase?
                  If Leased, Provide Lease Term (in years)
                  Special Requirements (Describe on the right)                                               Describe:
                     (eg. plumbing, electrical, HVAC, etc.)



          E. Complete for Major Equipment Purchase or Major System Only

                Site preparation requirements (Y/N?)                                                   If "Yes", Give Brief Description:

                Outside Consultant or Services Needed (Y/N?)                                           If "Yes", Give Brief Description:
                Lease or Purchase?
                If Leased, Provide Lease Term (in years)

                Other Special Requirements (describe briefly at right):                                      Describe:




capitalbud/0708/b50dd606-2eec-4b55-817d-cc3fb9935c06.xls
     II. COMPLETION DATE OF CAPITAL ASSET:                                                                        III. EST. USEFUL LIFE OF CAPITAL ASSET:
         Month & year when completed asset is needed
         Month:                Year:                                                                                 No. of Years:
                                                                                                                   (Follow guidelines provided)

     IV. TOTAL COST & FUNDING SOURCE BY YEAR:
         Enter amounts by year as appropriate:                                  Yr. 1                Yr. 2               Yr.3           Yr. 4        Yr. 5        Add'l. Yrs.    Total

         A. TOTAL COST OF CAPITAL ASSET:                                                                                                                                                 $0
          ( Enter total cost in the year that costs will be incurred.)
          (Include site preparation & all other costs necessary to bring the capital asset to use. Should not include debt service costs. See attached note)

         B. FUNDING SOURCE(S) TO ACQUIRE ASSET (Enter $dollar amount of the source in each year that it is to be received. See important instructions & example on attached note).            Description
               No Funding Source Identified (Indicate "Yes" if true)         (If yes, borrowing is required. Complete debt & interest amortization in V.B. below & complete V.D.)
                    (Borrowing Required)
                                                                               Yr. 1                 Yr. 2              Yr. 3           Yr. 4        Yr. 5        Add'l. Yrs.    Total
                 Gift                                                                                                                                                                  $0
                 Endowment                                                                                                                                                             $0
                 Grant (indicate "approved" or "applied")                                                                                                                              $0
                 School/VP Incentive Plan                                                                                                                                              $0
                 Operations-Existing Expense Budget                                                                                                                                    $0
                              Total Funding Sources:                                    $0                   $0                 $0              $0           $0             $0           $0

         C. NET AMOUNT OF (DEBT) REQUIRED                                               $0                   $0                 $0              $0           $0             $0           $0


     V. INCREMENTAL IMPACT ON OPERATING BUDGET:
        Enter additional operating revenue or expense expected                  Yr. 1                Yr. 2              Yr. 3           Yr. 4         Yr.5        Add'l. Yrs.    Total
        from the requested capital asset for each year that it is
        realized or incurred.

         A. INCREMENTAL OPERATING REVENUE (describe at right):

         B. INCREMENTAL OPERATING EXPENSE: (describe at right):
               Salary & Benefits
                 Maintenance & Repairs
                 Utilities
                 Cleaning
                 Contracted Services
                 Other Expenses
                 Lease Expense
                 Debt & Interest Repayment Transfers (Amortization)                                                                                                                    $0
                   (A debt amortization schedule must be calculated
                   & provided whenever money is to be borrowed to
                   to acquire the asset. Compute the amortization
                   schedule per the instructions in the attached note.
                   Call Assoc. VP Finance Ofc. at Ext. 2765 if you
                   need assistance.)
                        Total Operating Expenses:                                       $0                   $0                 $0              $0           $0

         C. NET OPERATING REVENUE (EXPENSE):                                            $0                   $0                 $0              $0           $0




capitalbud/0708/b50dd606-2eec-4b55-817d-cc3fb9935c06.xls
         D. Number of Years To Retire Project Debt:                          No. of Years:                              (Note: May not exceed useful life of the asset)

                 (Complete only if (1) No funding source has been identified to acquire the asset (as indicated in the first item in IV.B.)
                                   (2) Only a partial funding source has been identified to acquire the asset as indicated in V.B.
                                   (3) A funding source has been identified in IV. B., but all or part of it is not available at the time that the asset is acquired


         (DO NOT GO BELOW THIS LINE---FOR REVIEWERS ONLY)
     VI. REVIEWED BY:
           FACILITIES MGT:                                                      DOIT:                                                                       REQUEST NO.
           (Construction, renovations)                                          (System Software)

                                                                                ASSOCIATE VP FINANCE:
           PURCHASING:                                                          (Projects where debt is required)
           (Major equipment purchases)
                                                                                BUDGET OFFICE:

         REVIEWER COMMENTS

         Facilities Mgt:




         Purchasing:




         DOIT:




         Assoc. VP Finance:




         Budget Office:




         This form may be obtained on the Budget Office Web Site under Budget Process/Capital Budget/Forms)
                                                                                                                                                                          Yes
                                                                                                                                                                          No
                                                                                                                                                                          N/A
                                                                                                                                                                          Lease
                                                                                                                                                                          Purchase
                                                                                                                                                                          N/A
                                                                                                                                                                          January
                                                                                                                                                                          February
                                                                                                                                                                          March
                                                                                                                                                                          April
                                                                                                                                                                          May
                                                                                                                                                                          June
                                                                                                                                                                          July
                                                                                                                                                                          August
                                                                                                                                                                          September
                                                                                                                                                                          October
                                                                                                                                                                          November
                                                                                                                                                                          December

                                                                                                                                                                                2006
                                                                                                                                                                                2007
                                                                                                                                                                                2008
                                                                                                                                                                                2009
                                                                                                                                                                                2010
capitalbud/0708/b50dd606-2eec-4b55-817d-cc3fb9935c06.xls                                                                                                                        2011
                                                               2012
                                                               2013
                                                               2014
                                                               2015
                                                               2016
                                                               2017
                                                           X




capitalbud/0708/b50dd606-2eec-4b55-817d-cc3fb9935c06.xls

				
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posted:8/11/2011
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Description: Schedule Request Form document sample