Effective: July 1, 1999
Revised: July 2011
Review Date: July 2013
Grant Proposal Clearance Form
Project Director (Principal Investigator) __________________________________________________
Co-Director (Co-Principal Investigator) __________________________________________________
Unit (Program/Office) Name(s) ________________________________________________________
Title of Proposal ____________________________________________________________________
Brief Description:
Agency or Organization to receive proposal: _____________________________________________
Agency or Organization Program Name: _________________________________________________
Type of application:
New
Continuation (If continuation, Banner Index #_____________)
Period of Support Requested: From _______________ to ______________
Business Services will assign a Proposal Preparation number when the proposal is first presented to
the Director.
Reviews/Certifications/Assurances
Yes No Will the project require renovations or modifications to current university facilities or additional
new space? (This includes expanded utility service to support additional equipment, e.g. computer, fume hoods, air
conditioning, etc.) If yes, please attach detailed description to this form and obtain approval of the Provost.
Yes No Will the project involve human subjects, animals, controlled substances, radioactive substances,
genetically altered materials or hazardous substances. If yes, please attach a detailed description to this form and
obtain approval of Business Services and Institutional Review Board (if applicable).
Yes No Do you as PD, any family member or any of the involved researchers or their family members
have consulting agreements, management responsibilities or substantial equity (greater than $10,000 in value or
greater than 5% total equity) in the sponsor, subcontractor or in the technology? If yes, please attach a detailed
description to this form and obtain approval of the Provost.
Yes
No Does this proposal involve participation of American Indian or other minority communities? If yes,
attach a detailed description to this form and obtain appropriate approvals from these communities.
