Office of Institutional Grants
Internal Approval Form
Submission Deadline: _________ No deadline: __________ Application: ____ New ____ Continuation
Project Director/PI: __________________________________ PI DSU ID: _________________________________________
College/School of: ___________________________________ Department/Division: _______________________________
Proposal Data
Funder/Sponsor: ______________________________________________________________________________________
Title of Project: _______________________________________________________________________________________
Type of Funder: ____ Federal ____ State ____ Local ____ Private/Non-Profit ____ Other University
Budget Information
Initial Budget Period From: _________ To: _________ Total Budget Period From: _________ To: ________
(mm/dd/yyyy) (mm/dd/yyyy)
Initial Budget Total Budget
Requested Direct: $______________ Requested Direct: $______________
Requested Indirect: $______________ Requested Indirect: $______________
Total Request: $______________ Total Request: $______________
Give reason if indirect is not included: _____________________________________________________________________
(Please include indirect rate at federal negotiated rate unless otherwise directed by funder.)
Cost-Sharing (Match) Terms of Funding:
In Kind: $______________ ____ Cost-reimbursement
Cash: $______________ ____ Advance
Total: $______________ ____ Installments
Project Director (PD)/Project Investigator (PI) Disclosures and Assurances
By signing below, I certify the following:
The information submitted with the application is true, complete and accurate to the best of my knowledge.
I understand that any false, fictitious, or fraudulent statements or claims may be subject to penalties.
I have no financial interests that presents an actual or potential conflict of interest in this project.
I have not been barred or suspended from doing business with the federal government.
I have submitted an initial Request for IRB Clearance to the Institutional Review Board.
Exemption # _________ N/A _________
Furthermore, if funded, I will conduct the project in accordance with the terms and conditions of the sponsoring agency and
the policies of the University, and I will be fully responsible for meeting the requirements of the award, including providing the
proper stewardship of the funds, and submitting all required technical reports and deliverables on a timely basis.
Project Director/PI Signature _____________________________ Date _____________________________________
By signing below, I certify that I have had the opportunity to review the above-described proposal and I approve it for
submission to the funder listed above.
Please return completed form with proposal & budget attached to the Office of Institutional Grants, Kent Wyatt Hall 248
no later than 4 business days prior to the submission deadline. Proposals submitted less than 4 days will not be reviewed.
PD/PI is responsible for obtaining signatures in this column:
Director of Institutional Grants:
Signature Date
Department/Division Chair:
Signature Date
Dean, Graduate & Continuing Studies & Research:
Signature Date
Dean:
Signature Date
Provost/Vice President of Academic Affairs:
Signature Date
Chief Technology Officer (if equipment is included):
Signature Date
Vice President of Finance and Administration:
Signature Date
(For Internal Use Only)
Date ________________
S-Number: _____________________
Funded Not Funded
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