Download Morehouse College Proposal Transmittal Form

Morehouse College Proposal Transmittal Form
Proposal Title:
Principal Investigator:
Ext:
Department:
Co-Principal Investigator:
Ext:
Department:
Co-Principal Investigator:
Ext:
Department:
Granting Agency:
Agency Deadline:
Agency Division:
Grant/Contract #:
Agency Address:
# Copies for Agency:
URL (web guideline address) _____________________________________
Proposal For:
Grant
Contract
Subcontract
Co-op Agreement
Purpose:
Research
Training
Equipment
Career/Fellowship
Other
Type:
New
Continuation
Renewal
Supplement
Research
st
st
1 Year Direct Costs $
Multi-Yr.(s) Total Direct Costs $
Proposal Project Period:
1 Year Total $
Total Indirect Costs $
Start Date:
Total Costs $
End Date:
Faculty Release Time per semester:
FA (Indirect Cost Rate:)
st
1 Year Indirect Costs $
Start date:
%
Cost Sharing:
Approved by:
Source:
Regulatory Approvals: (Complete where applicable to project)
Yes
No
Does the Proposal Involve:
Human Subjects: If yes, Complete the following:
Approved: Approval Date
Pending: Date Submitted:
Vertebrate Animals: If Yes, complete the following:
Approved: Approval Date
or
Pending: Date Submitted:
Recombinant DNA: If Yes, Exempt
or Date Approved
Radioactive Substances: Date approved by Safety Office
Hazardous Chemicals: Date approved by Safety Office
Does this proposal include a subcontract to another institution? Institution
Investigator Certifications: My signature below certifies that I) I am not delinquent on any federal debts; 2) I am not presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded from current transactions by any federal department or agency; 3) I have not and
will not lobby any federal agency on behalf of this award; 4) I am aware and agree to abide with Morehouse’s Drug Free Workplace policy; 5) I will
abide by the College’s research policies including the Sponsored Research and Technology Transfer, and 6) I agree to be bound by the terms and
conditions of the outside grant or contract which supports this proposed activity and, in consideration of the information and facilities made available to
me by Morehouse or the outside sponsor, to assign copyright and patent rights to Morehouse in Accordance with the terms and conditions of
Morehouse’s Patent and Copyright policies.
____________________________________________
Principal Investigator (Signature Required)
Date
_________________________________________________________
Co-Investigator (Signature Required)
Date
____________________________________________
_________________________________________________________
Department Head
Dean
Date
College Endorsement: The attached proposal has been examined by the officials whose signature appear below. The principal academic review of
the proposal is the responsibility of the Department/Division/Center and College. These signatures indicate that the signers are familiar with the
proposal, are satisfied with and are responsible for all commitments in the proposal as they relate to their areas (space/personnel/financial/etc.)
_____________________________________________
Director, Office of Sponsored Programs
Date
_________________________________________________________
Director, Special Projects
Date
_____________________________________________
Vice President for Business & Finance/CFO
Date
_________________________________________________________
Vice President for Institutional Advancement
Date
______________________________________________
Senior Vice President for Academic Affairs
Date
_________________________________________________________
Vice President for Campus Operations
Date
(required only if requesting special facilities)
•
Private sector sources are defined as companies, corporations, foundations and individuals.
Updated 7/12/2004