This award proposal has been reviewed and preliminarily approved by:
___________________________________ _________ _____________________________________ _________
Project Director Applicant Date Department Head Date
___________________________________ _________ _____________________________________ _________
Dean of College Date Director of Grants and Sponsored Programs or Designee Date
Arkansas Tech University Grants, Contracts and Sponsored Programs
University Approval to Submit Proposal Form
Title of Project
Date
Project Director
Department
Granting Agency
CFDA Number
If Federal Funds
Yes
No
Does a conflict, potential conflict, violation, or potential violation, of the Code of Ethics and Conflict of Interest Policy
for Grants, Contracts, and Special Programs exist for this program application? (If yes, please attach explanation for review)
Yes
No
Will human subjects be used in the program?
Yes
No
Will animals or an animal care facility be used in the program?
Yes
No
Will radioactive materials be used in the program?
Yes
No
Will hazardous materials be used in the program?
Yes
No
Will biological agents or toxins restricted by the USA Patriot Act be used in the program?
Yes
No
Is there a copyright or patent potential?
NOTE: If the answer is yes to any of the above questions, the investigator must attach appropriate documentation of approval or justification for use and/or
purchase and the proposal may be subject to review by the Grants, Gifts and Sponsored Research Committee, Institutional Review Board (human subjects),
Institutional Bio-Safety Committee, Institutional Animal Care and Use Committee, University Counsel, and/or other board/committee(s) as needed.
Proposal Request
Total Matching (attach documentation)
Total Request
After Dean's approval, please forward completed form and proposal to the Office of Sponsored Programs and University Initiatives
1509 N Boulder, Administration Building, Room 207, Russellville, AR 72801, to begin the final review process.
Final Review:
___________________________________ _________ _____________________________________ _________
Budget and Special Programs Director Date Associate Vice President of Sponsored Programs and Date
University Initiatives or Designee
____________________________________________ _________
Appropriate Vice President or Ozark Chancellor (if cost sharing is required) Date
After Vice President approval, please return completed form and proposal to the
Office of Sponsored Programs and University Initiatives for processing.
Form updated 08-08-16
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