Proposal Submission Form

PI must submit Completed and Signed Proposal Submission Form to ORSP with each application for funding prior to Submission Deadline

Proposals that were submitted to external sponsors without first completing the Proposal Submission Form may be withdrawn or refused at the discretion of the AVP of Research.

Once you submit this form, you may NOT go back to make changes. You can use the Save and Resume Later link at the end of the form to make changes prior to submitting the form.

Note: Attachments will only be saved upon final submission of the form.

Investigator Information

Principal Investigator/Project Director Name*

Prefix (optional)

First Name

Last Name

PI College/Unit*

PI Dept. or Center*

PI Title*

PI Phone*

PI Email*

Co-PI Information. Please include the Co-PIs' Names, College, Dept/Center, Title, Phone and Email*

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File uploads may not work on some mobile devices.

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Co-PI #1

Co-PI #1 Name*

Prefix (optional)

First Name

Last Name

Co-PI #1 Email*

Co-PI #1 College/Unit*

Co-PI #1 Dept. or Center*

Co-PI #2

Co-PI #2 Name*

Prefix (optional)

First Name

Last Name

Co-PI #2 Email*

Co-PI #2 College/Unit*

Co-PI #2 Dept. or Center*

Co-PI #3

Co-PI #3 Name*

Prefix (optional)

First Name

Last Name

Co-PI #3 Email*

Co-PI #3 College/Unit*

Co-PI #3 Dept. or Center*

Co-PI #4

Co-PI #4 Name*

Prefix (optional)

First Name

Last Name

Co-PI #4 Email*

Co-PI #4 College/Unit*

Co-PI #4 Dept. or Center*

Co-PI #5

Co-PI #5 Name*

Prefix (optional)

First Name

Last Name

Co-PI #5 Email*

Co-PI #5 College/Unit*

Co-PI #5 Dept. or Center*

Co-PI #6

Co-PI #6 Name*

Prefix (optional)

First Name

Last Name

Co-PI #6 Email*

Co-PI #6 College/Unit*

Co-PI #6 Dept. or Center*

Co-PI #7

Co-PI #7 Name*

Prefix (optional)

First Name

Last Name

Co-PI #7 Email*

Co-PI #7 College/Unit*

Co-PI #7 Dept. or Center*

Co-PI #8

Co-PI #8 Name*

Prefix (optional)

First Name

Last Name

Co-PI #8 Email*

Co-PI #8 College/Unit*

Co-PI #8 Dept. or Center*

Co-PI #9

Co-PI #9 Name*

Prefix (optional)

First Name

Last Name

Co-PI #9 Email*

Co-PI #9 College/Unit*

Co-PI #9 Dept. or Center*

Co-PI #10

Co-PI #10 Name*

Prefix (optional)

First Name

Last Name

Co-PI #10 Email*

Co-PI #10 College/Unit*

Co-PI #10 Dept. or Center*

ORSP Information

ORSP #*

If you don't know what the ORSP# is, contact the Office of Research & Sponsored Programs at (239) 590-7549.

Project Information

Project Title*

Type of Project*

Applied Research Basic Research Community Service Instruction Library Services Public Broadcasting Student Activities Training Fellowship, list entity and country (if not U.S.) below.

Type of Submission*

New Proposal Continuaton Supplement Pre-Proposal/LOI

Fellowship Entity (and Country if not in the U.S.)*

Proposed Project Start Date*

Proposed Project End Date*

Is this proposal being submitted on behalf of a center or institute?*

Yes No

Center or Institute Name*

Is this proposal being submitted as a subaward to another institution?*

Yes No

Pass-Through Entity's Name*

Pass-Through Entity's Type*

Institution of Higher Education (State-FL-owned) Institution of Higher Education (private-owned) Institution of Higher Education (State-owned Non-FL) Foreign Entity Non-Profit Industry

Other:

Direct Sponsor Name*

Specify the originating funding agency or entity*

Flow-Through only

Other Sponsor Type*

Program Name and Opportunity No. from RFP

CFDA Number/Assistance Listing Number (ALN)

Needed for Federal and Federal Flow-through projects

Proposal Deadline*

Is this a Collaborative Proposal*

Yes No

If Yes, please list Each Collaborating Institution & PI for that Institution*

Budget Information

Total Amount Requested* $

Cost Share or Match Required/Included?*

Yes No

Amount of Cost Share or Match* $

Cost share or match cannot be voluntary. If Cost share or match is required, list source(s) and amount(s) of Cash in In-Kind Match. This is an obligation of your department/college that must be tracked separately from the award funding.*

Cost share cannot be volunteered

If not using FGCU's federaly approved indirect Cost Rate of 42% MTDC, select one of the other options.

Indirect Cost Rate*

Other (explained)*

Indirect Cost Rate Documentation*

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File formats accepted: pdf, doc, docx

If rate is sponsor designated/not allowed by sponsor, please upload RFP or other grant documentation confirming this. If Indirect is to be used as match, please upload email approval from AVP for Research (please note: emails must be uploaded as a PDF document).

Does this proposal involve one or more Departmentally Approved Course Buyout(s) for FGCU faculty?*

Yes No

If Yes, list faculty name(s), department(s) and number of credits

List Faculty Name and Number of credits requested*

Do you currently have any independent contracts with any foreign entity or work that involves foreign entities?*

No, the work on this project does not involve any foreign entities The work on this project involves 1 foreign entity The work on this project involves 2 foreign entities The work on this project involves 3 or more foreign entities

If 3 or more foreign entities are involved, please upload a file indicating the name, scope of work, and role for the each foreign entity listed.

1a. Name of foreign entity*

1b. Scope of foreign entity's work*

1c. Role of foreign entity*

2a. Name of foreign entity*

2b. Scope of foreign entity's work*

2c. Role of foreign entity*

Upload a file indicating the name, scope of work, and role for the each foreign entity listed*

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File formats accepted: pdf, doc, docx, txt, csv, xls, xlsx, zip

Please initial*

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Your initial indicates that you have responded truthfully regarding foreign researchers and foreign entities.

Compliance

Does this proposal meet the definition of Fundamental Research (basic and applied research in science and engineering, the results of which ordinarily are published and shared broadly within the scientific community)?*

Yes No

This project involves:

Animal Subjects*

Yes No

Biological Hazards*

Yes No

Chemical Hazards*

Yes No

Controlled Substances*

Yes No

Copyright Issues*

Yes No

Dangerous Gases*

Yes No

Explosives*

Yes No

Hazardous Waste*

Yes No

HIPAA Covered Data*

Yes No

Human Subjects*

Yes No

Intellectual Property*

Yes No

Laser Technology*

Yes No

Nanoparticles*

Yes No

Patent Issues*

Yes No

Pathogens*

Yes No

Proprietary Information*

Yes No

Radioactive Materials*

Yes No

Recombinant DNA*

Yes No

SCUBA Diving*

Yes No

Special Permits*

Yes No

Stem Cells*

Yes No

Export Controls*

Yes No

See International Information section below

Foreign Owned*

Yes No

See International Information section below

Foreign Subaward*

Yes No

See International Information section below

International Travel*

Yes No

See International Travel section below

International Visitors*

Yes No

See International Travel section below

Financial Conflict of Interest*

Yes No

See Financial Conflict of Interest section below

International Information – if any boxes referring to international information are checked, the appropriate Export Control Form must be completed. See the Export Controls page on the Research and Sponsored Programs website. The information and rules apply to funded and nonfunded projects.

Name of entity of foreign ownership*

Names of entities affiliated with foreign ownership*

ex: University or business

Roles of entities affiliated with foreign ownership*

Name of entity of foreign subaward*

Names of entities affiliated with foreign subaward*

ex: University or business

Roles of entities affiliated with foreign subaward*

Number of International Visitors*

1 International Visitor 2 International Visitors 3 International Visitors More than 3 International Visitors

Name of international visitor #1*

Names of entities affiliated with international visitor #1*

ex: University or business

Country of visitor #1's most recent citizenship*

Name of international visitor #2*

Names of entities affiliated with international visitor #2*

ex: University or business

Country of visitor #2's most recent citizenship*

Name of international visitor #3*

Names of entities affiliated with international visitor #3*

ex: University or business

Country of visitor #3's most recent citizenship*

Upload a file of information for the international visitors. Include each visitor's name, the name of the entity affiliated with that visitor, the country of that person's most recent citizenship.*

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File uploads may not work on some mobile devices.

File formats accepted: pdf, doc, docx, txt

International Travel – If International Travel is checked, the PI and any other traveler must consult with the FGCU Global Engagement Office on university policies and procedures supporting academic related international travel. International travel preparations will require advanced planning to ensure appropriate immigration, risk management and university support services are in place. The FGCU International Travel Registry in the Global Engagement Office website must be submitted at least 30-days prior to travel for international travel. PI is responsible for knowing and complying with all host country requirements and protocols for conducting research at destinations outside of the U.S.

Financial Conflict of Interest – All investigators have read and understand Financial Conflict of Interest in Sponsored Research and have made all required disclosures. Please complete the Financial Conflict of Interest Form.

Principal Investigator/Project Director Disclosures and Assurances

All applicable items contained in the Compliance Checklist have been identified. Investigators agree to abide by any obligations that university policies, guidelines, or legal requirements governing these items may envoke (e.g. obtaining approval for protocols, abiding by export control laws, maintaining confidentiality, etc.)*

True False

I agree that I am the employee responsible for the preparation of the proposal submitted. The information submitted within the proposal is true, complete, and accurate.*

True False

I agree that I have not made false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties.*

True False

I agree to accept responsibility for the scientific conduct of the project and to provide the required progress and effort reports if a grant is awarded as a result of the application.*

True False

I am not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by any Federal department or agency.*

True False

I have not been convicted of, or had a civil judgment rendered against me for the commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public transaction or contract under a public transaction.*

True False

I am not in violation of federal or state antitrust statutes.*

True False

I have not been convicted of or had a civil justment rendered agains me for the commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property.*

True False

I presently have not been indicted or otherwise criminally or civilly charged by a government entity (federal, state, local) with commission of any offenses.*

True False

I have not, within a three-year period preceding this application had one or more public transactions (federal, state, local) terminated for cause or default.*

True False

I have read and understand the policies and regulations of financial conflict of interest, including institutional policy.*

True False

I certify that the proposed research work will be performed in compliance with sponsor and institutional policies, procedures and requirements. If the proposal is funded and accepted by the university, I will conduct the project in accordance with the terms and conditions of the sponsoring agency, guidelines and policies of the unviersity and I will be fully responsible for meeting the requirements of the award, including, but not limited to, provding the proper stewardship of sponsored funds, submitting all required technical reports and deliverables on a timely basis, properly disclosing all inventions, and adhering to all federal compliance requirements (e.g. Export Control, HIPAA, Human Research Participants, etc.).*

True False

PI Signature*

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Use your mouse or finger to draw your signature above

Date of PI Signature*

Assignment of Credit

The objective of this section below is to assign credit to the research areas listed below. The information provided identifies particular areas of investigation for data collection. Primary Investigators should be identified in the top row of the table below. Use whole percentages for all entries identifying the percent of responsibility of each person in the proposed areas. These percentages need not represent salary or time distributions. Add a section for each investigator as needed.

Make sure that the Project Grand Total equals 100%

Upload Assignment of Credit percentages for all investigators including the PRIMARY investigator.*

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Primary Investigator Assignment of Credit

PI
Name*

Prefix (optional)

First Name

Last Name

PI
Total %

PI
Business %

PI
Engineering %

PI
Education %

PI
Justice Studies%

PI
Chemistry & Physics %

PI
Marine & Ecological Sciences %

PI
Social Sciences %

PI
Psychology%

PI
Biological Sciences %

PI
Mathematics %

PI
Music & the Arts %

PI
Health Sciences %

PI
Counseling & Social Work %

PI
Rehabilitation Sciences %

PI
Information and Library Management/Sciences/Studies

PI
Other %

Co-Investigator #1 Assignment of Credit

Co-PI #1
Name*

Prefix (optional)

First Name

Last Name

Co-PI #1
Total

Co-PI #1
Business %

Co-PI #1
Engineering %

Co-PI #1
Education %

Co-PI #1
Justice Studies %

Co-PI #1
Chemistry & Physics %

Co-PI #1
Marine & Ecological Sciences %

Co-PI #1
Social Sciences %

Co-PI #1
Psychology %

Co-PI #1
Biological Sciences %

Co-PI #1
Mathematics %

Co-PI #1
Music & the Arts %

Co-PI #1
Health Sciences %

Co-PI #1
Counseling & Social Work %

Co-PI #1
Rehabilitation Sciences %

Co-PI #1
Information and Library Management/Sciences/Studies

Co-PI #1
Other %

Co-Investigator #2 Assignment of Credit

Co-PI #2
Name*

Prefix (optional)

First Name

Last Name

Co-PI #2
Total %

Co-PI #2
Business %

Co-PI #2
Engineering %

Co-PI #2
Education %

Co-PI #2
Justice Studies %

Co-PI #2
Chemistry & Physics %

Co-PI #2
Marine & Ecological Sciences %

Co-PI #2
Social Sciences %

Co-PI #2
Phychology %

Co-PI #2
Biological Sciences %

Co-PI #2
Mathematics %

Co-PI #2
Music & the Arts %

Co-PI #2
Health Sciences %

Co-PI #2
Counseling & Social Work %

Co-PI #2
Rehabilitation Sciences %

Co-PI #2
Information and Library Management/Sciences/Studies

Co-PI #2
Other %

Co-Investigator #3 Assignment of Credit

Co-PI #3
Name*

Prefix (optional)

First Name

Last Name

Co-PI #3
Total %

Co-PI #3
Business %

Co-PI #3
Engineering %

Co-PI #3
Education %

Co-PI #3
Justice Studies %

Co-PI #3
Chemistry & Physics %

Co-PI #3
Marine & Ecological Sciences %

Co-PI #3
Social Sciences %

Co-PI #3
Psychology %

Co-PI #3
Biological Sciences %

Co-PI #3
Mathematics %

Co-PI #3
Music & the Arts %

Co-PI #3
Health Sciences %

Co-PI #3
Counseling & Social Work %

Co-PI #3
Rehabilitation Services %

Co-PI #3
Information and Library Management/Sciences/Studies

Co-PI #3
Other %

Co-Investigator #4 Assignment of Credit

Co-PI #4
Name*

Prefix (optional)

First Name

Last Name

Co-PI #4
Total %

Co-PI #4
Business %

Co-PI #4
Engineering %

Co-PI #4
Education %

Co-PI #4
Justice Studies %

Co-PI #4
Chemistry & Physics %

Co-PI #4
Marine & Ecological Sciences %

Co-PI #4
Social Sciences %

Co-PI #4
Psychology %

Co-PI #4
Biological Sciences %

Co-PI #4
Mathematics %

Co-PI #4
Music & the Arts %

Co-PI #4
Health Sciences %

Co-PI #4
Counseling & Social Work %

Co-PI #4
Rehabilitation Services %

Co-PI #4
Information and Library Management/Sciences/Studies

Co-PI #4
Other %

Co-Investigator #5 Assignment of Credit

Co-PI #5
Name*

Prefix (optional)

First Name

Last Name

Co-PI #5
Total %

Co-PI #5
Business %

Co-PI #5
Engineering %

Co-PI #5
Education %

Co-PI #5
Justice Studies %

Co-PI #5
Chemistry & Physics %

Co-PI #5
Marine & Ecological Sciences %

Co-PI #5
Social Sciences %

Co-PI #5
Psychology %

Co-PI #5
Biological Sciences %

Co-PI #5
Mathematics %

Co-PI #5
Music & the Arts %

Co-PI #5
Health Sciences %

Co-PI #5
Counseling & Social Work %

Co-PI #5
Rehabilitation Services %

Co-PI #5
Information and Library Management/Sciences/Studies

Co-PI #5
Other %

Co-Investigator #6 Assignment of Credit

Co-PI #6
Name*

Prefix (optional)

First Name

Last Name

Co-PI #6
Total %

Co-PI #6
Business %

Co-PI #6
Engineering %

Co-PI #6
Education %

Co-PI #6
Justice Studies %

Co-PI #6
Chemistry & Physics %

Co-PI #6
Marine & Ecological Sciences %

Co-PI #6
Social Sciences %

Co-PI #6
Psychology %

Co-PI #6
Biological Sciences %

Co-PI #6
Mathematics %

Co-PI #6
Music & the Arts %

Co-PI #6
Health Sciences %

Co-PI #6
Counseling & Social Work %

Co-PI #6
Rehabilitation Services %

Co-PI #6
Information and Library Management/Sciences/Studies

Co-PI #6
Other %

Co-Investigator #7 Assignment of Credit

Co-PI #7
Name*

Prefix (optional)

First Name

Last Name

Co-PI #7
Total %

Co-PI #7
Business %

Co-PI #7
Engineering %

Co-PI #7
Education %

Co-PI #7
Justice Studies %

Co-PI #7
Chemistry & Physics %

Co-PI #7
Marine & Ecological Sciences %

Co-PI #7
Social Sciences %

Co-PI #7
Psychology %

Co-PI #7
Biological Sciences %

Co-PI #7
Mathematics %

Co-PI #7
Music & the Arts %

Co-PI #7
Health Sciences %

Co-PI #7
Counseling & Social Work %

Co-PI #7
Rehabilitation Services %

Co-PI #7
Information and Library Management/Sciences/Studies

Co-PI #7
Other %

Co-Investigator #8 Assignment of Credit

Co-PI #8
Name*

Prefix (optional)

First Name

Last Name

Co-PI #8
Total %

Co-PI #8
Business %

Co-PI #8
Engineering %

Co-PI #8
Education %

Co-PI #8
Justice Studies %

Co-PI #8
Chemistry & Physics %

Co-PI #8
Marine & Ecological Sciences %

Co-PI #8
Social Sciences %

Co-PI #8
Psychology %

Co-PI #8
Biological Sciences %

Co-PI #8
Mathematics %

Co-PI #8
Music & the Arts %

Co-PI #8
Health Sciences %

Co-PI #8
Counseling & Social Work %

Co-PI #8
Rehabilitation Services %

Co-PI #8
Information and Library Management/Sciences/Studies

Co-PI #8
Other %

Co-Investigator #9 Assignment of Credit

Co-PI #9
Name*

Prefix (optional)

First Name

Last Name

Co-PI #9
Total %

Co-PI #9
Business %

Co-PI #9
Engineering %

Co-PI #9
Education %

Co-PI #9
Justice Studies %

Co-PI #9
Chemistry & Physics %

Co-PI #9
Marine & Ecological Sciences %

Co-PI #9
Social Sciences %

Co-PI #9
Psychology %

Co-PI #9
Biological Sciences %

Co-PI #9
Mathematics %

Co-PI #9
Music & the Arts %

Co-PI #9
Health Sciences %

Co-PI #9
Counseling & Social Work %

Co-PI #9
Rehabilitation Services %

Co-PI #9
Information and Library Management/Sciences/Studies

Co-PI #9
Other %

Co-Investigator #10 Assignment of Credit

Co-PI #10
Name*

Prefix (optional)

First Name

Last Name

Co-PI #10
Total %

Co-PI #10
Business %

Co-PI #10
Engineering %

Co-PI #10
Education %

Co-PI #10
Justice Studies %

Co-PI #10
Chemistry & Physics %

Co-PI #10
Marine & Ecological Sciences %

Co-PI #10
Social Sciences %

Co-PI #10
Psychology %

Co-PI #10
Biological Sciences %

Co-PI #10
Mathematics %

Co-PI #10
Music & the Arts %

Co-PI #10
Health Sciences %

Co-PI #10
Counseling & Social Work %

Co-PI #10
Rehabilitation Services %

Co-PI #10
Information and Library Management/Sciences/Studies

Co-PI #10
Other %

Grand Total for Project Assignment of Credit

Grand Total % for Project Assignment of Credit

Grand Total for Project Assignment of Credit Must Equal 100%

I affirm that the Grand total for the Project Assignment of Credit is equal to 100%.

The Grand Total above equals 100%*

True

File Attachment

Attach Project Summary/Abstract, Budget, Budget Justification and other required documentation in ONE pdf document.

Project Summary/Abstract, Budget, Budget Justification and other required documentation*

No File Chosen

File uploads may not work on some mobile devices.

File format accepted: pdf

Conflict of Interest

Proposals that were submitted to external sponsors without first completing the proposal submission process may be withdrawn at the discretion of the AVP of Research

Pursuant to Federal regulations, the Principal Investigator certifies to the following statements:
1. The information submitted within the application is true, complete, and accurate.
2. Any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties.
3. I agree to accept responsibility for the scientific conduct of the project and to provide the required progress and effort reports if a grant is awarded as a result of the application.

I certify that:
a. I am not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by any Federal department or agency.
b. I have not, within a three-year period preceding the application, been convicted of, or had a civil judgment rendered against me for:
i. Commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public transaction or contract under a public transaction;
ii. Violation of federal or state antitrust statutes; or
iii. Commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property.
c. I presently, have not been indicted or otherwise criminally or civilly charged by a government entity (federal, state, local) with commission of any of the offenses enumerated in (4) above or,
d. I have not, within a three-year period preceding this application had one or more public transactions (federal, state, local) terminated for cause or default.
e. I have read and understand the policies and regulations of conflict of interest, including institutional policy.
f. I certify that the proposed research work will be performed in compliance with sponsor and institutional policies, procedures and requirements.

Do you, your spouse, domestic partner or children have a financial interest which may directly and significantly affect the design, conduct or reporting of this project?*

Yes No

Does the PI, any Co-PI, or any FGCU employee receiving salary or involved in this funding have a financial conflict of interest with fellow PI’s or the funder?*

Yes No

Complete the Financial Conflict of Interest Form. (https://www.fgcu.edu/academics/research/researchcompliance/financial-conflict-of-interest-form)

Initials*

[clear]

Use your mouse or finger to draw your initials above

*The Principal Investigator verifies that all investigators have read and understand FGCU’s Financial Conflict of Interest Policy 2.018.

The PI's Department Chair/Center Director and Dean or Division Head must review and sign this form. Upon submission, the form will be forwarded to the people listed below.

Name of PI's Department Chair or Center Director*

Prefix (optional)

First Name

Last Name

Email Address of PI's Department Chair or Center Director*

Name of PI's Dean or Division Head*

Prefix (optional)

First Name

Last Name

Email Address of PI's Dean or Division Head*

Name of Co-PI #1's Department Chair or Center Director*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #1's Department Chair or Center Director*

Name of Co-PI #1's Dean or Division Head*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #1's Dean or Division Head*

Name of Co-PI #2's Department Chair or Center Director*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #2's Department Chair or Center Director*

Name of Co-PI #2's Dean or Division Head*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #2's Dean or Division Head*

Name of Co-PI #3's Department Chair or Center Director*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #3's Department Chair or Center Director*

Name of Co-PI #3's Dean or Division Head*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #3's Dean or Division Head*

Name of Co-PI #4's Department Chair or Center Director*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #4's Department Chair or Center Director*

Name of Co-PI #4's Dean or Division Head*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #4's Dean or Division Head*

Name of Co-PI #5's Department Chair or Center Director*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #5's Department Chair or Center Director*

Name of Co-PI #5's Dean or Division Head*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #5's Dean or Division Head*

Name of Co-PI #6's Department Chair or Center Director*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #6's Department Chair or Center Director*

Name of Co-PI #6's Dean or Division Head*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #6's Dean or Division Head*

Name of Co-PI #7's Department Chair or Center Director*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #7's Department Chair or Center Director*

Name of Co-PI #7's Dean or Division Head*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #7's Dean or Division Head*

Name of Co-PI #8's Department Chair or Center Director*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #8's Department Chair or Center Director*

Name of Co-PI #8's Dean or Division Head*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #8's Dean or Division Head*

Name of Co-PI #9's Department Chair or Center Director*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #9's Department Chair or Center Director*

Name of Co-PI #9's Dean or Division Head*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #9's Dean or Division Head*

Name of Co-PI #10's Department Chair or Center Director*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #10's Department Chair or Center Director*

Name of Co-PI #10's Dean or Division Head*

Prefix (optional)

First Name

Last Name

Email Address of Co-PI #10's Dean or Division Head*

Once you submit this form, you may NOT go back to make changes. You can use the Save and Resume Later link below to make changes prior to submitting to the form.

Note: Attachments will only be saved upon final submission of the form.

PI Signature*

[clear]

Use your mouse or finger to draw your signature above

Date*

Assurance from ORSP Grant Coordinator

If the ORSP# in the ORSP Information section near the top of the form is not valid, you can correct it.

The application identified above has been reviewed by the undersigned. The review includes the ORSP#, project information and the budget information.

ORSP Grant Coordinator's Comment

Name of ORSP Grant Coordinator*

Prefix (optional)

First Name

Last Name

Signature of ORSP Grant Coordinator*

[clear]

Use your mouse or finger to draw your signature above

Date of ORSP Grant Coordinator's Signature*

Assurance from PI's Department Chair

If the ORSP# in the ORSP Information section near the top of the form is not valid, you can correct it.

The application identified above has been reviewed by the undersigned. The review included the overall budget request, allowability of direct cost charging, individual commitments of effort, rates of compensation, stipend levels, requests for equipment and justification presented, and allocation of adequate space and facilities.

PI's Department Chair Approval*

Approval is GIVEN for the proposed activities to be undertaken in this unit by the personnel identified in the proposal, and for any cost sharing as described in the budget plan. Approval is WITHHELD for the proposed activities to be undertaken in this unit by the personnel identified in the proposal, and for any cost sharing as described in the budget plan.

Reason for PI's Department Chair Denial (optional)

Name of PI's Department Chair or Center Director*

Prefix (optional)

First Name

Last Name

Signature of PI's Department Chair or Center Director*

[clear]

Use your mouse or finger to draw your signature above

Date of PI's Department Chair or Center Director Signature*

Assurance from PI's College Dean or Authorized Representative

If the ORSP# in the ORSP Information section near the top of the form is not valid, you can correct it.

The application identified above has been reviewed by the undersigned. The review included the overall budget request, allowability of direct cost charging, individual commitments of effort, rates of compensation, stipend levels, requests for equipment and justification presented, and allocation of adequate space and facilities.

Approval from the PI's Department Chair was withheld. You can see the PI Department Chair section above for the reason.

PI's College Dean Approval*

Approval is GIVEN for the proposed activities to be undertaken in this unit by the personnel identified in the proposal, and for required cost share in the budget plan. Approval is WITHHELD for the proposed activities to be undertaken in this unit by the personnel identified in the proposal, and for required cost share in the budget plan.

Reason for PI's College Dean Denial (optional)

Name of PI's College Dean or Division Head*

Prefix (optional)

First Name

Last Name

Signature of PI's College Dean or Division Head*

[clear]

Use your mouse or finger to draw your signature above

Date of PI's College Dean or Division Head's Signature*

Assurance from Co-PI #1's Department Chair or Authorized Representative

If the ORSP# in the ORSP Information section near the top of the form is not valid, you can correct it.

The application identified above has been reviewed by the undersigned. The review included the overall budget request, allowability of direct cost charging, individual commitments of effort, rates of compensation, stipend levels, requests for equipment and justification presented, and allocation of adequate space and facilities.

If approval from the PI's Department Chair or College Dean was withheld. You can see those sections above for the reasons.

Co-PI #1's Department Chair Approval*

Approval is GIVEN for the proposed activities to be undertaken in this unit by the personnel identified in the proposal, and for required cost share in the budget plan. Approval is WITHHELD for the proposed activities to be undertaken in this unit by the personnel identified in the proposal, and for required cost share in the budget plan.

Reason for Co-PI #1's Department Chair Denial (optional)

Name of Co-PI #1's Department Chair*

Prefix (optional)

First Name

Last Name

Signature of Co-PI #1's Department Chair*

[clear]

Use your mouse or finger to draw your signature above

Date of Co-PI #1's Department Chair Signature*

Assurance from Co-PI #1's College Dean or Authorized Representative

If the ORSP# in the ORSP Information section near the top of the form is not valid, you can correct it.

The application identified above has been reviewed by the undersigned. The review included the overall budget request, allowability of direct cost charging, individual commitments of effort, rates of compensation, stipend levels, requests for equipment and justification presented, and allocation of adequate space and facilities.

If approval from the PI's Department Chair or College Dean was withheld. You can see those sections above for the reasons.

Co-PI #1's College Dean Approval*

Approval is GIVEN for the proposed activities to be undertaken in this unit by the personnel identified in the proposal, and for required cost share in the budget plan. Approval is WITHHELD for the proposed activities to be undertaken in this unit by the personnel identified in the proposal, and for required cost share in the budget plan.

Reason for Co-PI #1's College Dean Denial (optional)

Name of Co-PI #1's College Dean or Division Head*

Prefix (optional)

First Name

Last Name

Signature of Co-PI #1's College Dean or Division Head*

[clear]

Use your mouse or finger to draw your signature above

Date of Co-PI #1's College Dean or Division Head's Signature*

Assurance from Co-PI #2's Department Chair or Authorized Representative

If the ORSP# in the ORSP Information section near the top of the form is not valid, you can correct it.

The application identified above has been reviewed by the undersigned. The review included the overall budget request, allowability of direct cost charging, individual commitments of effort, rates of compensation, stipend levels, requests for equipment and justification presented, and allocation of adequate space and facilities.

If approval was withheld by anyone above, you can see those sections for the reasons.

Co-PI #2's Department Chair Approval*

Approval is GIVEN for the proposed activities to be undertaken in this unit by the personnel identified in the proposal, and for required cost share in the budget plan. Approval is WITHHELD for the proposed activities to be undertaken in this unit by the personnel identified in the proposal, and for required cost share in the budget plan.

Reason for Co-PI #2's Department Chair Denial (optional)

Name of Co-PI #2's Department Chair*

Prefix (optional)

First Name

Last Name

Signature of Co-PI #2's Department Chair*

[clear]

Use your mouse or finger to draw your signature above

Date of Co-PI #2's Department Chair Signature*

Assurance from Co-PI #2's College Dean or Authorized Representative

If the ORSP# in the ORSP Information section near the top of the form is not valid, you can correct it.

The application identified above has been reviewed by the undersigned. The review included the overall budget request, allowability of direct cost charging, individual commitments of effort, rates of compensation, stipend levels, requests for equipment and justification presented, and allocation of adequate space and facilities.

If approval was withheld by anyone above, you can see those sections for the reasons.

Co-PI #2's College Dean Approval*

Approval is GIVEN for the proposed activities to be undertaken in this unit by the personnel identified in the proposal, and for required cost share in the budget plan. Approval is WITHHELD for the proposed activities to be undertaken in this unit by the personnel identified in the proposal, and for required cost share in the budget plan.

Reason for Co-PI #2's College Dean Denial (optional)

Name of Co-PI #2's College Dean or Division Head*

Prefix (optional)

First Name

Last Name

Signature of Co-PI #2's College Dean or Division Head*

[clear]

Use your mouse or finger to draw your signature above