Fillable Proposal Routing Sheet (New Mexico Institute of Mining & Technology)

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Proposal Routing Sheet (New Mexico Institute of Mining & Technology)

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Routedoc16.doc REV. September 2, 2016
R&ED Proposal No.:________________________
Directions: Attach this Routing Sheet to your original proposal and fill in as much information as you can. Sign this sheet and have your
Department Chair sign it. Then send the proposal to Sponsored Projects Administration Office (Wells Hall). The offices listed at the bottom
of this sheet will review the proposal and sign to indicate approval. The R&ED Database Administrator will photocopy your proposal and then
return the original to you. Your proposal cannot be submitted until the routing process is complete.
Brief title of proposal:
Agency to which proposal will be submitted:
Submission to the following Federal Agency required:
! NSF ! DOE ! Grants.gov ! NSPIRES (NASA) ! OTHER, will be submitted by the PI Due Date:
Type of Proposal:
! NEW ! RENEWAL ! REVISED BUDGET ! Cost Reimbursement ! Fixed Price (
Budget justification is not
required)
Proposed start date of project:
End date:
Principal Investigator(s):
Dept:
Phone:
Email:
TOTAL FUNDING REQUESTED IN THIS PROPOSAL:
Total Direct Costs: $ _________________________
Total Indirect Costs: $ _________________________
Total Overall Cost & Fee: $ _________________________
Indirect Cost Rate used: __________________________
Indirect Cost Rate Entitled: __________________________
STUDENT SUPPORT REQUESTED IN THIS PROPOSAL:
Undergraduate: $ _________________________
Graduate: $ _________________________
Total Student Support: $ _________________________
Does Agency require Overhead to be waived? ! NO ! YES -- Please attach copy of requirement by Agency
Does Agency require Cost-Sharing?
!
NO ! YES – Percentage Required:
Are Cost-Sharing/Matching Funds included in this proposal?
!
NO ! YES -- Please provide the following information:
Source:
________________________
________________________
________________________
NM Tech Acct. Number:
_______________________
_______________________
_______________________
Approval (Required before Routing!):
______________________________
______________________________
______________________________
HUMAN SUBJECTS / ANIMAL RESEARCH: ALL projects involving human or animal subjects must be reviewed and approved
by Tech’s IRB or IACUC before research can begin.
This project WILL involve: ! HUMAN SUBJECTS ! ANIMALS
Have all research staff (including the PI) completed the required training course? ! NO ! YES
Principal Investigator:
Date:
Department Chair or Supervisor:
Date:
Sponsored Projects Administration:
Date:
VP for Academic Affairs:
Date
VP for Research & Economic Development:
Date
VP for Administration & Finance:
Date
President:
Date:
Research Service Specialist:
Date:
COMMENTS (Please attach another sheet if you need more space):
Proposal Routing Sheet
0.00
2/19/20
Conflict of Financial Interest Disclosure Form
Proposal Title:
Agency to which proposal is being submitted:
Principal Investigator (PI):
Dept:
Phone:
Email:
I have read the Conflict of Interest Policy
(https://www.nmt.edu/research/docs/policies/ConflictOfInterestPolicy.pdf) enacted by the New
Mexico Institute of Mining and Technology, and hereby state that: (check one)
I have no significant financial interests to disclose related to the proposed research at this
time. I will file a new Conflict of Financial Interest Disclosure Form if any change occurs
during the contract period.
I have the following significant financial interests to disclose which may be related to
the proposed research:
PI Signature: Date:
click to sign
signature
click to edit
Export Control Exclusion Screening
Principal Investigator (PI): Answer the following questions and return to the Sponsored Projects Administrator
(SPA) working on your proposal/grant/contract/agreement.
Proposal Ti
tle: PI:
Funding
Agency/Institution: Proposal Number:
Previous # (if co
ntinuation): Est. Start Date:
Fundamental Research Exclusion
Yes
No
Unknown
Will the information be published and shared broadly in the scientific
community?
Are there any proprietary or U.S. government publication or access
dissemination restrictions in the contract?
Are there any restrictions on foreign national participation or requirements for
U.S. citizens only in the contract?
Will there be any foreign nationals and/or persons holding dual citizenship
involved with the project? * Provide the name and nationality of each
individual if known or when available.
Is any of the project equipment export controlled? (If new, describe in
"Additional Information" Section)
Is any portion of the project being conducted at a site other than NMT?
(SubAwardees, Collaborators, Consultants, Other [select one]).
* If “Yes,” Where?
Will items and/or materials be shipped outside the United States?
*
If “Yes,” What? Where? and To Whom?
Is travel outside the US anticipated? * If “Yes,” Where?
Educational Information Exclusion
Is the information commonly taught at schools and universities? (Please see
Export Control Exclusion Screening Tip Sheet for more information.)
Are courses about this information listed in published course catalogs?
Other Terms Mentioned or Discussed Within the Project
d
ocumentation
If “Yes” is indicated, please include a brief description.
Encryption Software? * If yes, fill out the “Checklist for Encryption
Software…” form from the Office of Research - Compliance office
unknown at this time
Select Agents? *If “Yes,” What is it?
Trade Secrets?
Sanctioned or Embargoed countries? *If “Yes,” Name?
ITAR (International Traffic in Arms Regulation) or Munitions List? *If yes
EAR (Export Administration Regulations) or Export Control? *If “Yes,”#
*ADDITIONAL INFORMATION
***IMPORTANT NOTICE TO PI***
Consequence of Non-Compliance
Failure to comply with US export control laws can result in severe penalties to the individual that can
include the following: Civil penalties up to $500,000 for each violation; Criminal penalties can be applied
up to $1,000,000 each violation; and/or Imprisonment for up to 10 years.
PI Signature:
Date:
Print PI
Name: Phone/Email:
Received By (Pre Award
SPA): Date:
_______
_______________________________________________________________________________________
For Internal Office Use Only:
Reviewer (Print):
Reviewer signature:
Date:
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Proposal Routing Sheet (New Mexico Institute of Mining & Technology)

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Completed 24 August 2020

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