Core Facility Questionnaire

Name of Service Center or Core Facility

Facility URL/Website Address

Choose a category/categories that best describes your core facility.

Name of Core Director

Email Address of Core Director

School/Unit

Department

Name of Faculty Director (if applicable)

Email Address of Faculty Director (if applicable)

Name of Business Manager/Finance Approver

Email Address of Business Manager/Finance Approver

Name of Dean or Center Director

Email Address of Dean or Center Director

Where is the facility physically located (campus/building/room number)

Provide a summary about the facility's purpose.

Provide a list of services to be provided.

Describe the demand for this facility.

What is the estimated number of users?

Identify the primary source of users (i.e. which schools/departments/companies).

What is the estimated/projected annual revenue/expense recovery for this core facility?

Less than or equal to $25K

Greater than $25K

If greater than $25K, provide estimated/projected annual amount.

What is the estimated/projected usage per month for this core facility?

Under 10 requests (monthly)

10-20 requests (monthly)

Over 20 requests (monthly)

Does this facility overlap with an existing facility?

Yes

No

Maybe

If you're aware of an overlap, please explain why we need duplication.

List staff required to provide service.

List equipment (or provide a link to list).

List other major required needs.

Will this center require new space?

Yes

No

How many square feet?

Will the space need to be remodeled?

Yes

No

Please describe the scale of the remodel with approximate cost.

Provide source of funding for staff.

Provide source of funding for equipment.

Provide source of funding for remodeling, if applicable.

Provide chart string for account that covers deficit funding. If this core rolls up to a different Unit and Division, provide the Unit and Division name and value.

How will the rates be measured (i.e. hourly, per unit, etc.)?

33. After submitting this form, please complete a Rate Calculation Template (sample provided) and return to University Core Facilities Group. For new facilities, please provide a letter from a department chair and dean or center director (RCM unit head) authorizing the creation of this facility and describing their support to University Core Facilities Group.

I understand I need to complete the Rate Calculation template and obtain the appropriate letters.

Core Facility Questionnaire

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