Real Estate Office – RE-1 Form Exhibit 1

Exhibit 1

NCSU Lease Request For Space

Any University department proposing to rent space from a private property owner must complete this form whether the desired lease is an original or a renewal. The request should be forwarded to NCSU Real Estate (Box 7230). The requesting department should complete all numbered items on the form. Questions should be addressed to Real Estate (Phone 515-3235).If bids are required, the requesting department pays newspaper ad charges.

1. Department: ___________________________________________________________________________

2. Why is this space needed? ________________________________________________________________

______________________________________________________________________________________

3. State preference for general location and give justification for preference: _____________________________

______________________________________________________________________________________

4. What available properties have been examined? Will they meet your needs? ___________________________

______________________________________________________________________________________

______________________________________________________________________________________

5. Special requirements for space (special air conditioning, special wiring, special telephone, computers and other related equipment, copy machine, etc.): _____________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

6. Duration of lease: ______________________________________________________________________

7. Original ______ or renewal ______

8. Desired commencement date of lease: _________________________________________

9. Fund sources:

a. For rental: Account No. _____________________________________________________________

Project Name and No. ______________________________________________________________

b. For janitorial and utilities: _____________________________________________________________

c. For requirements if needed beyond the upfitting allowance by lessor:

_________________________________________________________________________________

d. For restoring upon vacating premises: ____________________________________________________

10. Gross square feet needed: _________________________________________________________________

11. Acceptable cost per square foot range (with janitorial and utilities):

12. Attach organization chart of those to occupy leased space and work sheet used in computing gross square feet needed.         Number of people to occupy space: _________

Fax No. _____________ Box No. __________

13. Requestor: _____________ Phone Number:_____________   Date:_____________

14. Department Head: ____________________________________________ Date: _________________

15. Dean’s Office: By: ____________________________________________ Date: _________________