UCSD -- Real Estate -- Off Campus Space Request

Fields marked with an Asterisk are required fields.
Questions may be directed to the Real Estate office at x47480 or x41488.

Requesting Department Information

Department *
Department Contact First Name *
Department Contact Last Name *
Ext. *
Mail Code
Contact fax
Contact e-mail *

New Lease Information

Length of Term Requested (enter value in number of months) *
Number of Individuals *
Number of Parking Spaces Needed *
Approximate Square Feet *
Approximate Monthly Rent *
Proposed Usage (i.e. : Office, Research, Medical, Lab, etc.) *

Site Information at

Please provide site information listed below. UCSD Real Estate will work with department contact regarding lease negotiations. Please do not negotiate any lease terms.
If REQUEST IS FOR A SPECIFIC SPACE:
Street Address of Property
City
State
Zip Code
First Name of Landlord
Last Name of Landlord
First Name of Landlord Contact
Last Name of Landlord Contact
Landlord Contact's Street Address
City
State
Zip code
Telephone
Previous Use of Space
Tenant Improvements Needed, if Known(describe)
IF REQUEST IS FOR A GENERAL AREA:
Area of San Diego: (e.g., Kearny Mesa, Hillcrest, La Jolla)

If the new lease involves a relocation from your existing facility complete the following:

Current Street Address *
Current City *
Current State *
Current Zip code *
Landlord's First Name
Landlord's Last Name
Landlord's Address
Landlord's Telephone
Expiration Date of Current Lease
Current Monthly Rent $
APPROXIMATE RELOCATION COSTS:
Moving Cost $
Telephones $
Computers $
Other $
If choosing 'Other' please specify the relocation costs

Funding Information for new lease and relocation costs:

Funding Sources: A) State Support; B) User Fees; C) Federal Funds; D) Medical School Clinic Fees; E) Teaching Hospital/Medical; F) Opportunity/Off-the-Top Funds; G) Other
If choosing 'Other' please specify the funding source
NEW LEASE
Type of First Source:
Percent of First Source %
Type of Second Source:
Percent of Second Source %
Type of Third Source:
Percent of Third Source %
RELOCATION COST
Type of First Source:
Percent of First Source %
Type of Second Source:
Percent of Second Source %
Type of Third Source:
Percent of Third Source %
* Any EH&S Inspections/reviews required will be charged to this Index Number.
Fund/Org Number *
Index Number *
* Any EH&S Inspections/reviews required will be charged to this Index Number.

When your request is submitted you will receive an email from realestate@ucsd.edu. This will be your receipt. Please make a copy, and obtain the necessary approval signatures. Mail the copy with signatures to the Real Estate Office (Mail Code 0982).

Work will only begin once the approval signatures are received by Real Estate.