Fillable Request for No-Cost Extension (East Tennessee State University)

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Request for No-Cost Extension (East Tennessee State University)

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ETSU Box 70565, Johnson City, Tennessee 37614 | 423-439-6052 | research@etsu.edu
Last updated 5/3/17
EAST TENNESSEE STATE UNIVERSITY
OFFICE OF RESEARCH AND SPONSORED PROGRAMS
Request for No-Cost Extension
Please complete and forward this form to ORSPA at least 60 days prior to the termination date.
Date:
___ 1
st
Request ___ 2
nd
Request
Principal Investigator Name:
Sponsor Name:
ORSPA Number:
Banner Index Number:
Current Termination Date:
Requested Termination Date:
Indicate the percent of total effort committed to this project during the requested extension.
Key Personnel Name
Role (Principal Investigator,
Co-Investigator, Investigator, etc.)
% Effort
Effort Change
Yes
No
Justification for extension: (The fact that funds remain is not sufficient justification for an extension.)
Compliance: All compliance issues (UCAC, IRB, IBC) must be resolved for this proposed no-cost
extension time period. Attach a copy of the most recent approval.
Yes
No
Protocol Number(s)
Most Recent Approval Date
Signatures: By signing below, the PI certifies that the request for extension is consistent with sponsor policy and that there
is no conflict with other time and effort commitments during the extension period.
Principal Investigator
Chair
Dean
ORSPA Use Only
Action taken:
Signature:
Date:
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Request for No-Cost Extension (East Tennessee State University)

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Completed 20 August 2020

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