Department Authorization Form

Requirements

Please fill out the Department Authorization Form, have it signed, and email to Director of Real Estate Department at realestateoffice@re.ucla.edu. If you have any questions regarding the form, call Matt Ceragioli at (310) 206-3323. 

If you do not have Adobe Acrobat, please call UCLA Information Technology Services Support Center for assistance at (310) 267-4357(HELP), or email at help@it.ucla.edu.

PLEASE NOTE:

Individual(s) signing the Department Authorization Form must have delegation of authority over the funding source. 

Department Chair/COO Ambulatory and Community Practices Endorsement is required for all medical space.

Form

To download a copy, click on the applicable link below:

• UCLA Health System Department Authorization Form
• UCLA Campus Department Authorization Form