Sponsor Request Form
This form is for use of adding a sponsor to appear in electronic systems for a research award, DSB, eGrants or eIRB.
Should this be for a Subrecipient in eGrants, you will also need to provide the DUNS number at the bottom of the form.
*Indicates a required field
Add
Change
Reactivate (Choose One)
Please circle all which apply below:
DSB Sponsor
Y or N
eGrants - Sponsor or Subrecipient (Section 10.1)
eIRB or Velos
Y or N
If Subrecipient is chosen, see note at bottom
PeopleSoft Sponsor Number:
(Only required if changing sponsor or adding location)
*Requester:
Phone:
Dept:
General Information
Effective Date: (mm/dd/yyyy):
This date will be the start of the current Fiscal Year unless a different date is entered. A Fiscal Year begins on 9/1.
*Sponsor Legal Name (40-character limit):
Preferred short name or acronym (10-character limit):
*Address Location
Location # (if known) :
Country (5-character limit):
Address Line 1 (55-character limit):
Address Line 2 (55-character limit):
Address Line 3 (55-character limit):
City (30-character limit):
State (6-character limit):
Zip Code (12-character limit):
*Select Sponsor Type (Choose one if known)
Academic (ACAD)
Institutional (INST)
Public: Federal (FEDL)
Public: Local (LOCL)
Industry: For-Profit (INDU)
Private: Non-Profit (NONP)
Public: State of Texas (STTX)
*Other Essential Information (If applicable)
Federal
Foreign
Letter of Credit
Letter of Credit Sponsor (Enter in Sponsor Code or Name):
*For Subrecipient please provide DUNS #
E-mail Form To: sponsors@utsouthwestern.edu
Sponsor Addition - Change Request Form
Rev 6.0
Page 1