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Proposal Submission for DSS (when form is completed please click on SUBMIT button)
Location:
Requestor:   
Requestor Email:
Emails to cc:
Additional PIs:

Proposal title: long
Proposal title: short

Sponsor name:   
Sponsor contact:
email:
phone:

Proposal
Due date: Announcement number - RFP#
Start date:
End date:

Type of proposal:
Purpose:
Recipient funding type:

Is this proposal a subcontract or is the sponsor a clinical research organization? Yes No
If yes, please name prime sponsor


Conflict of interest number:
Date:
Conflict Indentified: Yes No


Budget Numbers
Number of months on project - (apply to each below)
PI:
Additional PI:

Post doc - salary + time on project:
Grad Students - number of students + time on project:
Undergrads - number of students + time on project:

Any additional details:



Equipment $5000+

Materials - specific supplies


Travel
where:
conference fee estimate:
kind of meeting
# of Travelers
# of days

Consultants Name:
Daily Rate:
# of days

Sub-contracts:
A formal technical and cost proposal is required for each subcontractor.

Questions:
Will this project involve the use of sponsor equipment, consultants, or an off-campus location; generate income; split F&A between departments, or; include the extended absence of any key personnel?
Yes No

Have you discussed any issues with the sponsor - or signed any agreements - related to confidentiality, publications, ownership, data, patents, licenses, or intellectual property?
Yes No

Will your project require additional university resources for its performance?
Yes No

Is this proposal a clinical trial?
Yes No

Have you or anyone involved with this project ever been debarred or suspended from receiving Federal funds, been delinquent on any Federal debt, or used any Federal funds for lobbying activities?
Yes No

Will any part of your project be conducted in, involve travel to, involve personnel from, or be sponsored by a company from another country?
Yes No

Will any non-U.S. citizen or non-U.S. permanent resident (i.e. faculty, staff, students, post-doctoral trainees) assist or be involved with this project in any way?
Explain:


Will there be any foreign travel by you or key personnel as part of this project?
Explain:


Will your project be subject to approval from the IRB or IACUC?
Yes No

Any additional comments:



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