ORA ID: ________________
PI Name:
Project Title:
I. UA Cost Share
All cost share committed in the proposal must be identified by source and approved by the individual with
authority for the listed account.
1. Commitments can be split if the cost will be shared. Show the amounts and account number for each portion of the commitment.
2. Faculty who provide cost share from their F&A, start-up, or grant account must sign for the commitment.
3. The department chair must sign for commitments from a department account (faculty AY effort, GA stipends, equipment, etc.)
4. The college dean must sign for commitments from a college account (GA stipends, equipment, etc.)
5. For cost shared F&A, provide only the description and amount. You do not need to identify an account or obtain a signature.
6. For cost share to be provided by recovered F&A from this project you do not need to identify an account, but must obtain the signature
of the person(s) whose share of the F&A is being committed.
*If cost share adjustments are required at time of award, this form must be revised and submitted to ORA.
Description of cost shared items
(College, Dept., grant)
Account Number
Name of Approver
II. Personnel Commitments Requiring Departmental ApprovalGrant funded effort
Please list all faculty who will commit AY time to the project and any other staff who will commit CY time. These must be a
pproved by the
employee’s chair or supervisor.
Check if load
Name of Approver
III. Other Modifications Requiring Approvals - If this project will require facility modifications or impose unusual or costly
infrastructure demands, you must receive clearance from the appropriate administrative unit and have identified a funding source to
cover these costs.
Description of need: Funding source: Approved by:
Revised 11/16
Will be completed by ORA
IV.Third Party Cost Share - Identify the source and amount of any cost share commited by a third party. Documentation from source(s) must also
be provided.