I. Institutional Information
Name of Institution:

Type of Institution (check all that apply):
Public
Private
Two-Year
Four-Year

Total student enrollment:

Total GIE:

Total facilities budget for the current fiscal year:

Number of FTE employees:

II. Institutional Contacts

Contact person for this application:

Office address of contact:

City:

State:

Zip:

Telephone:

Fax:

E-mail:

Public relations or media relations contact:

I hereby verify that to the best of my knowledge the statements contained herein accutately reflect the circumstances reported.

Chief Facilities Officer Signature:

I hereby verify that to the best of my knowledge the statements contained herein accutately reflect the circumstances reported.

Chief Executive Officer Signature:

Office address:

Telephone:

Fax:

E-mail:

In order to complete the submission process, please check off your APPA region:
Eastern: Joe Rubertone, Quinnipiac University
Southeastern: Elizabeth Sisk, University of Memphis
Midwestern: Ernie McVay, Ohio State University
Rocky Mountain: Jeff Butler, University of Montana
Central: Art Jones, Black Hills State University
Pacific: Anthony Guerrero, University of Washington/Bothell

Questions? Call 703-684-1446.

Please attach your electronic submission file below. You may submit up to 5 separate files.

Attachment 1:
Attachment 2:
Attachment 3:
Attachment 4:
Attachment 5: