Fillable PROPOSAL SUMMARY AND APPROVAL FORM (Clark University)

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PROPOSAL SUMMARY AND APPROVAL FORM (Clark University)

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PROPOSAL SUMMARY AND APPROVAL FORM
Office of Sponsored Programs and Research
See instructions at: http://www.clarku.edu/offices/research/proposals/instructionform.cfm
PART I: PRINCIPAL INVESTIGATOR / PROJECT DIRECTOR INFORMATION
Principal Investigator / Project Director
Phone
E-Mail
Home Department
If applicable, please note the Clark Institute or Center through which you are submitting this proposal:
Co-Principal Investigator / Project Director
Phone
E-Mail
Home Department
PI / PD Funded Effort on Project
Academic Year: Summer:
Co-PI / Co-PD Funded Effort on Project:
Academic Year: Summer
:
Project Title
Project Duration
From: To:
Primary Sponsor
Subcontracting Sponsor (if Clark is the recipient)
Is this a Preproposal?
Yes No
Was a Preproposal / LOI submitted for this grant?
Yes No
Project Location (Check One)
On-Campus Off-Campus
PART II I: PROJECT BUDGET INFORMATION
First Year Sponsor
Budget Request
Total Project Sponsor
Budget Request
Cost Sharing
(if applicable)
for First Year
Total Cost Sharing
(if applicable)
Capital Equipment > $5000
Total Direct Costs
F & A (Indirect Costs) _______
Total Project Costs
OSPR Use Only:
FFATA Required?
_____________
0.00%
PART IV: COMPLIANCE CONSIDERATIONS (Check all that apply)
Human Subjects
Animal Use
Recombinant DNA
Select Agents
Biohazards
Radioactive Materials
Toxic / Hazardous Materials
PART V: INSTITUTIONAL CONSIDERATIONS (Check all that apply)
Semester and Year
Conflict of Interest
Subcontracts
Patentable / Proprietary
Information
Anticipated Promotion
During Grant Period
____________________
Matching Funds
Consultants
Additional Non-Student
Personnel
Course Release
(unfunded)
________________
Capital Equipment
International
Project
Leave or Sabbatical
________________
Space / Renovations:
**CHAIR SIGNATURE REQUIRED**
PART VI : APPROVALS (Signatures must be obtained in order listed below)
In signing this, the Principal Investigator / Program Director agrees to comply with ALL Institutional and Funding Agency
policies and procedures which may apply as a result of an award, and certifies that the Clark University Conflict of Interest
Policy has been read. Clark University Conflict of Interest Policy here; Clark University Travel Policy here
Signature
Date
Principal Investigator / Program Director
Co-PI / Co-PD
Department Chair
Betsy Rempel
Associate Director of Corporate / Foundation Relations*
Jennifer Hitt
Director of Corporate / Foundation Relations*
Lisa Gaudette
Director of Sponsored Programs and Research
Yuko Aoyama
Associate Provost & Dean of Research and Grad Studies
* Required of all foundation and corporate sponsored programs.
Rev. February 2019
Course Buyout (grant-funded):
**CHAIR SIGNATURE REQUIRED**
Misc (add expanation)
Linda Cote
IRB and Grant Coordinator
*YOU MUST HAVE JULIE DOLAN SIGN BELOW for SPACE*
Julie Dolan
Signature required for space requests
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PROPOSAL SUMMARY AND APPROVAL FORM (Clark University)

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Completed 19 August 2020

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