Principal Investigator
Certifications
Principal Investigator (PI) must read, sign, and obtain necessary authorizations for this form.
(NOTE: Each Co-PI must read, sign, and obtain necessary authorizations on a separate Co-PI Certification Form.)
In compliance with Michigan Technological University’s policies, procedures and practices regar
ding the conduct of
externally funded activities, I certify the following:
1. I certify and attest that the information submitted within the accompanying application is original, true, complete, and accurate.
I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative
penalties. I agree to accept responsibility for the scientific conduct of the project and to provide the required progress reports if
a grant is awarded as a result of this application.
2. I certify that I have read and understand my responsibilities toward this sponsored project and, if funded, I will exercise
the responsibilities as outlined in Michigan Tech’s Sponsored Project Responsibilities.
3. I certify that I am neither presently debarred or suspended, proposed for debarment, declared ineligible, or voluntarily excluded
from participating in current transactions by any federal department or agency, and I am not delinquent on any federal debt.
4. I certify that I have read, understand, and will comply with the University’s Policy on Misconduct in Research, Scholarly
and Creative Endeavors.
5. I certify that I have read and understand Michigan Tech’s Conflict of Interest Policy (COIP) and Michigan Tech’s Conflict of
Interest Procedures and that I will comply with the COIP and all conditions or restrictions imposed by Michigan Tech to manage
conflicts of interest or I will forfeit the award. I further certify that I will continue to comply with the COIP throughout the life of
this project and will complete a new Conflict of Interest Disclosure form if circumstances arise that would warrant a positive
disclosure on sponsored projects.
6. If this application for funding is directly or indirectly from Public Health Service (PHS) agencies, I certify that I have read and
understand Michigan Tech’s Conflict of Interest Policy and Michigan Tech’s Conflict of Interest Procedures (PHS Specific), and
that I will comply with the Policy and Procedures throughout the life of this project and will continue to complete the annual
Conflict of Interest Disclosure Form for PHS projects or make modifications if circumstances arise that would warrant further
disclosure.
7. I certify that if I receive federal funding via any mechanism, I
agree to comply with all public/open access terms of the sponsor.
8. I certify that I am responsible for any short-fall in graduate student tuition and fees when budgeting in candidacy mode.
Principal Investigator (PI)
Conflict of Interest
No Yes
Principal Investigator Name (Please Print or Type) Prin
cipal Investigator Signature (Required) If yes, indicate date
disclosure filed:
Date
Date
Authorizing Signatures
Department Chair/Director Name (Please Print or Type) Department Chair/Director Signature Date
OR
College/School Dean Signa
ture or Executive (if applicable) Date
Center/Institute
Director Name (Please Print or Type)
Center/Institute
Director Signature (if applicable) Date
College/School Dean Name or Executive (Please Print or Type)
Electronic signatures are available on this document. Click on RED ARROW of the signature field and follow the prompts. Save the file, and email to the next signator.
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
