Fill - Free fillable Pre-Award Account Number Request Authorization (East Tennessee State University) PDF form

Box 70565, Johnson City, Tennessee 37614 423-439-6052 (fax) 423-439-6050 research@etsu.edu

Last updated 7/13

EAST TENNESSEE STATE UNIVERSITY

OFFICE OF RESEARCH AND SPONSORED PROGRAMS

Pre-Award Account Number Request Authorization

Principal Investigator:

Department/College:

Phone:

Proposal Title:

Sponsor:

Project Start Date:

ORSPA Proposal #:

Indicate year, if multi-year project:

Justification for the necessity of a Pre-award index:

The following documents must accompany this form:

 Correspondence from the awarding agency/sponsor indicating that an award is expected

 Copy of original submitted Internal Routing Form

 Proposal or Contract

 Detailed budget (including salary breakdown, benefits, travel, supplies, equipment, etc.)

 Proof of Compliance (FCOI, Human Subjects, Vertebrate Animals, and/or Biosafety) (if applicable)

My signature certifies that I understand that this pre-award index will be issued for short-term use only and will be re-

evaluated if the status remains in pre-award longer than 30 days.

________________________________________________ ______________________

Principal Investigator or Project Director Date

In the event funds are not forthcoming, all expenditures made from the new account will be charged to the following

department account name and number:

Department Name:

Department Index Number:

__________________________________________________ ______________________

Chair / Authorized Signature for Above Account Date

__________________________________________________ ______________________

Dean Date

__________________________________________________ ______________________

Fill Online, Printable, Fillable, Blank Pre-Award Account Number Request Authorization (East Tennessee State University) Form