Proposal Submission Form Header Image

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Proposals that were submitted to external sponsors without first completing the Proposal Submission Form may be withdrawn or refused at the discretion of the AVP of Research.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*
Add internal FGCU Co-PIs*
Co-PI Information. Please include the Co-PIs' Names, College, Dept/Center, Title, Phone and Email*
No File Chosen
File uploads may not work on some mobile devices.
File formats accepted: pdf, doc, docx, txt, csv, xls, xlsx

Co-PI #1

Co-PI #1 Name*

Co-PI #2

Co-PI #2 Name*

Co-PI #3

Co-PI #3 Name*

Co-PI #4

Co-PI #4 Name*

Co-PI #5

Co-PI #5 Name*

Co-PI #6

Co-PI #6 Name*

Co-PI #7

Co-PI #7 Name*

Co-PI #8

Co-PI #8 Name*

Co-PI #9

Co-PI #9 Name*

Co-PI #10

Co-PI #10 Name*

ORSP Information

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

Project Information

Type of Project*
Type of Submission*
Proposed Project Start Date*
Proposed Project End Date*
Is this proposal being submitted on behalf of a center or institute?*
Is this proposal being submitted as a subaward to another institution?*
Pass-Through Entity's Type*
Type of Sponsor*
Flow-Through only
Needed for Federal and Federal Flow-through projects
Proposal Deadline*
Is this a Collaborative Proposal*

Budget Information

$
Cost Share or Match Required/Included?*
$
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 Documentation*
No File Chosen
File uploads may not work on some mobile devices.
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?*
If Yes, list faculty name(s), department(s) and number of credits
Do you currently have any independent contracts with any foreign entity or work that involves 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.
Upload a file indicating the name, scope of work, and role for the each foreign entity listed*
No File Chosen
File uploads may not work on some mobile devices.
File formats accepted: pdf, doc, docx, txt, csv, xls, xlsx, zip
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)?*

This project involves:

Animal Subjects*
Biological Hazards*
Chemical Hazards*
Controlled Substances*
Copyright Issues*
Dangerous Gases*
Explosives*
Hazardous Waste*
HIPAA Covered Data*
Human Subjects*
Intellectual Property*
Laser Technology*
Nanoparticles*
Patent Issues*
Pathogens*
Proprietary Information*
Radioactive Materials*
Recombinant DNA*
SCUBA Diving*
Special Permits*
Stem Cells*
Export Controls*
See International Information section below
Foreign Owned*
See International Information section below
Foreign Subaward*
See International Information section below
International Travel*
See International Travel section below
International Visitors*
See International Travel section below
Financial Conflict of Interest*
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.

ex: University or business
ex: University or business
Number of International Visitors*
ex: University or business
ex: University or business
ex: University or business
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.*
No File Chosen
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.)*
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.*
I agree that I have not made false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties.*
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 am not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by any Federal department or agency.*
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.*
I am not in violation of federal or state antitrust statutes.*
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.*
I presently have not been indicted or otherwise criminally or civilly charged by a government entity (federal, state, local) with commission of any offenses.*
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.*
I have read and understand the policies and regulations of financial conflict of interest, including institutional policy.*
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.).*
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.*
No File Chosen
File uploads may not work on some mobile devices.
File formats accepted: pdf, doc, docx, txt, csv, xls, xlsx

Primary Investigator Assignment of Credit

PI
Name*

Co-Investigator #1 Assignment of Credit

Co-PI #1
Name*

Co-Investigator #2 Assignment of Credit

Co-PI #2
Name*

Co-Investigator #3 Assignment of Credit

Co-PI #3
Name*

Co-Investigator #4 Assignment of Credit

Co-PI #4
Name*

Co-Investigator #5 Assignment of Credit

Co-PI #5
Name*

Co-Investigator #6 Assignment of Credit

Co-PI #6
Name*

Co-Investigator #7 Assignment of Credit

Co-PI #7
Name*

Co-Investigator #8 Assignment of Credit

Co-PI #8
Name*

Co-Investigator #9 Assignment of Credit

Co-PI #9
Name*

Co-Investigator #10 Assignment of Credit

Co-PI #10
Name*

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%*

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?*
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?*
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*
Name of PI's Dean or Division Head*
Name of Co-PI #1's Department Chair or Center Director*
Name of Co-PI #1's Dean or Division Head*
Name of Co-PI #2's Department Chair or Center Director*
Name of Co-PI #2's Dean or Division Head*
Name of Co-PI #3's Department Chair or Center Director*
Name of Co-PI #3's Dean or Division Head*
Name of Co-PI #4's Department Chair or Center Director*
Name of Co-PI #4's Dean or Division Head*
Name of Co-PI #5's Department Chair or Center Director*
Name of Co-PI #5's Dean or Division Head*
Name of Co-PI #6's Department Chair or Center Director*
Name of Co-PI #6's Dean or Division Head*
Name of Co-PI #7's Department Chair or Center Director*
Name of Co-PI #7's Dean or Division Head*
Name of Co-PI #8's Department Chair or Center Director*
Name of Co-PI #8's Dean or Division Head*
Name of Co-PI #9's Department Chair or Center Director*
Name of Co-PI #9's Dean or Division Head*
Name of Co-PI #10's Department Chair or Center Director*
Name 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.

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.

Name of ORSP Grant Coordinator*
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*
Name of PI's Department Chair or Center Director*
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*
Name of PI's College Dean or Division Head*
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*
Name of Co-PI #1's Department Chair*
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*
Name of Co-PI #1's College Dean or Division Head*
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*
Name of Co-PI #2's Department Chair*
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*
Name of Co-PI #2's College Dean or Division Head*
Use your mouse or finger to draw your signature above
Date of Co-PI #2's College Dean or Division Head's Signature*

Assurance from Co-PI #3'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 #3's Department Chair Approval*
Name of Co-PI #3's Department Chair*
Use your mouse or finger to draw your signature above
Date of Co-PI #3's Department Chair Signature*

Assurance from Co-PI #3'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 #3's College Dean Approval*
Name of Co-PI #3's College Dean or Division Head*
Use your mouse or finger to draw your signature above
Date of Co-PI #3's College Dean or Division Head's Signature*

Assurance from Co-PI #4'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 #4's Department Chair Approval*
Name of Co-PI #4's Department Chair*
Use your mouse or finger to draw your signature above
Date of Co-PI #4's Department Chair Signature*

Assurance from Co-PI #4'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 #4's College Dean Approval*
Name of Co-PI #4's College Dean or Division Head*
Use your mouse or finger to draw your signature above
Date of Co-PI #4's College Dean or Division Head's Signature*

Assurance from Co-PI #5'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 #5's Department Chair Approval*
Name of Co-PI #5's Department Chair*
Use your mouse or finger to draw your signature above
Date of Co-PI #5's Department Chair Signature*

Assurance from Co-PI #5'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 #5's College Dean Approval*
Name of Co-PI #5's College Dean or Division Head*
Use your mouse or finger to draw your signature above
Date of Co-PI #5's College Dean or Division Head's Signature*

Assurance from Co-PI #6'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 #6's Department Chair Approval*
Name of Co-PI #6's Department Chair*
Use your mouse or finger to draw your signature above
Date of Co-PI #6's Department Chair Signature*

Assurance from Co-PI #6'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 #6's College Dean Approval*
Name of Co-PI #6's College Dean or Division Head*
Use your mouse or finger to draw your signature above
Date of Co-PI #6's College Dean or Division Head's Signature*

Assurance from Co-PI #7'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 #7's Department Chair Approval*
Name of Co-PI #7's Department Chair*
Use your mouse or finger to draw your signature above
Date of Co-PI #7's Department Chair Signature*

Assurance from Co-PI #7'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 #7's College Dean Approval*
Name of Co-PI #7's College Dean or Division Head*
Use your mouse or finger to draw your signature above
Date of Co-PI #7's College Dean or Division Head's Signature*

Assurance from Co-PI #8'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 #8's Department Chair Approval*
Name of Co-PI #8's Department Chair*
Use your mouse or finger to draw your signature above
Date of Co-PI #8's Department Chair Signature*

Assurance from Co-PI #8'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 #8's College Dean Approval*
Name of Co-PI #8's College Dean or Division Head*
Use your mouse or finger to draw your signature above
Date of Co-PI #8's College Dean or Division Head's Signature*

Assurance from Co-PI #9'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 #9's Department Chair Approval*
Name of Co-PI #9's Department Chair*
Use your mouse or finger to draw your signature above
Date of Co-PI #9's Department Chair Signature*

Assurance from Co-PI #9'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 #9's College Dean Approval*
Name of Co-PI #9's College Dean or Division Head*
Use your mouse or finger to draw your signature above
Date of Co-PI #9's College Dean or Division Head's Signature*

Assurance from Co-PI #10'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 #10's Department Chair Approval*
Name of Co-PI #10's Department Chair*
Use your mouse or finger to draw your signature above
Date of Co-PI #10's Department Chair Signature*

Assurance from Co-PI #10'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 #10's College Dean Approval*
Name of Co-PI #10's College Dean or Division Head*
Use your mouse or finger to draw your signature above
Date of Co-PI #10's College Dean or Division Head's Signature*

Assurance from ORSP Director

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 is withheld by the PI's Department Chair or College Dean or, if applicable, any of the Co-PI's Department Chairs or College Deans. You can see those sections above for the reasons.

Name of ORSP Approver*
Use your mouse or finger to draw your signature above
Date of ORSP Approver's Signature*