Workstation request form for C-wing, 4th floor Dept of Pediatrics, ACH

Please review the Policies and Procedures before completing this form.

There is a limited number of assigned workstations. Requests for assigned workstations must meet the following criteria:

Faculty members must have a primary appointment in the Department of Pediatrics
Faculty members can only request workstations for research staff who work at ACH 0.8 FTE or more (4 days per week, minimum).
Research staff who will use the workstation must be full-time (0.8 FTE or more) UCalgary or AHS employees
Priority will be given to those with one or more individuals each working 0.8 FTE or more at ACH (i.e., not total staff FTE)
Consideration will be given to faculty who have been granted an assigned workstation(s) as part of their contract

Only the electronic submission of this form will be accepted (no paper copies please) and incomplete information may delay your application. Please submit one form per Faculty member or research group. If you have issues with the form or questions about the research space allocation process, please contact Ashton Chugh

Faculty member name

Primary department affiliation

Priority will be given to primary DoP appointments

Section/Unit

Number of research staff working on-site at ACH 0.8 FTE or more

Total grant funding supporting research salaries

i.e. salary budget for the research program

Name of research staff member(s) who will use the workstation(s)

Name of research staff member(s) who will use the workstation(s)
	Name of research staff member(s) who will use the workstation(s)	Item weight

more items

Click on the "add" button to enter additional name(s) of staff members that will use the workstation(s).

Other space currently assigned to faculty member

e.g. Within ACH clinical areas or research institutes or other buildings/locations

Collection of personal information
Your personal information is collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection or use of this information, please visit our Access to Information page.