Request for Research Space
Lab Contact or Manager
Briefly describe the area of research:
Is the request for new or an addition to currently assigned space?
Is the requested space to support a new extramurally funded research study?
Please note faculty member's level of protected research time (e.g., 50%, 75%, etc.)
What type of space is being requested (please select all that apply)?
Does the investigator currently have space on the CHLA Campus? (outside of Saban or SRT)
If investigator currently has assigned space, please specify location and approximate square footage:
Is the investigator losing space in the hospital or anywhere on campus?
If yes, please elaborate
Approximately how many square feet of space is being requesting?
What is the anticipated use of the space (describe your anticipated research activities)?
How soon will the additional space be needed (please provide specific dates, if known)?
How long will the space be needed?
Please list all individuals who will need access to the requested space:
Employee Type (e.g. Volunteer, Postdoc, etc.)
Designated remote or onsite
Will patients patients be seen in this space?
If yes, please describe the use of patient space:
Will staff be making a high volume of phone calls? If yes, please elaborate on types of phone calls.
What percentage of time would staff be utilizing the requested space? Please elaborate by writing days and hours of the week.
Do all staff members work the same schedules or do they vary?
If employees are designated as onsite, are there options for them to occasionally work from home?
If yes, how often can they work from home?
EQUIPMENT, FURNITURE AND MATERIALS
Will office furniture be required?
If yes, please provide details below (i.e., number of desks, chairs, etc.)
Will patient records need to be stored in the requested space?
If yes, is offsite storage an option?
Will the investigator have equipment or materials they will be bringing?
If yes, select all that apply:
Please add items below:
If you have specialized equipment, please specify below:
There are specific IS needs? (e.g. additional data ports, etc.)
If yes, please provide details below.
Please upload your CV here
Should be Empty: