RSP Use Only:
Tip!: Tab from one data
entry field to the next.
G/C Control No.:___________________
University of Northern Iowa
Office of Research and Sponsored Programs
Funder’s Deadline:_________________
Proposal Routing & Approval Form
Application Date:___________________
(Date Submitted)
(Replaces Request for External Funds Form)
The Proposal Routing & Approval Form must be completed prior to proposal authorization by the Office of Research
and Sponsored Programs and proposal submission. Route the form to internal review personnel identified below along
with a copy of the final narrative and budget. Consult the Proposal Submission Guidelines
(http://www.uni.edu/rsp/submitting-proposals) for mandated RSP timelines and requirements. Attach additional sheets as
necessary for each section of this form.
PROJECT IDENTIFICATION (PI/PD = Principal Investigator/Project Director)
Primary PI/PD:
Dept.:
Dept./Org. to which grant account will be assigned if different from that of Primary PI/PD:
Co-PI/PD #1:
Dept.:
Co-PI/PD #2:
Dept.:
Title of Project:
Total Project Period:
through
Sponsoring Agency:
Sponsor’s Funding Opportunity Title (if known) :
Hard Copy by PI/PD
Submission Responsibility:
Electronically by PI/PD
1st Funding Period
BUDGET INFORMATION (round to nearest $)
Electronically by RSP
Total Project Period*
*Complete this column only if project has
multiple funding periods.
A) Funds Requested of Sponsor
1) Direct Costs………………………………...…....
$0.00
$0.00
2) Facilities & Administrative (Indirect) Costs...
$0.00
$0.00
**If sponsor restricts indirect cost rate to less than UNI’s
Federally negotiated rate, or RSP’s approved exceptions,
attach a copy of sponsor’s written policy.
(Rate: 0.00%**)
(Rate: 0.00%**)
(Base: $0.00)
(Base: $0.00)
3) Total Funds Requested of Sponsor (1+2).......…
$0.00
B) Matching or Cost Sharing Funds Are cost sharing or matching funds required by the sponsor?
$0.00
NO
YES
If no, avoid showing cost sharing in proposal unless Primary PI/PD is prepared to document cost sharing when proposal is awarded.
1) UNI Sources
a) Direct Costs: Obtain signature of authorized representative for each source of funds.
Dept. Abbrev.
Approval Signature
0
___________________________
$0.00
$0.00
___________________________
$0.00
$0.00
___________________________
$0.00
$0.00
$0.00
$0.00
b) Facilities & Administrative (Indirect) Costs..
c) Total UNI Sources (a+b)…………………..…
$0.00
2) Third Party, Non-UNI Sources: Please attach written evidence of third-party sources.
$0.00
a)
$0.00
$0.00
b)
$0.00
$0.00
c) Total Third Party, Non-UNI Sources (a+b)
$0.00
$0.00
3) Total Matching/Cost Sharing Funds (1.c.+2.c.)
$0.00
$0.00
Revised 4/11/2012
C) Total Project Budget (A.3.+B.3.)…..........…...….
$0.00
$0.00
SPECIAL APPROVAL SIGNATURES/VERIFICATIONS Please read carefully.
1 of 4
Does this proposal…
NO
YES Involve subawards to third party institutions or organizations that will be contributing substantive
programmatic work to the grant or contract? If yes, attach an endorsement letter from the third party’s
authorized institutional representative.
NO
YES Involve congressionally directed funds? If yes, obtain signature from the Special Assistant to the
President for Board and Governmental Relations (Pat Geadelmann), or her designee.
Signature:________________________________
NO
YES Require additional space, or alteration or renovation of existing space? If yes, obtain signature from the
Assistant Vice President for Facilities Planning/Campus Architect (Philip A. Simpson), or his designee.
Signature:________________________________
NO
Date:_________________________
Date:_________________________
YES Involve human subjects? (This includes projects expecting to be certified as “exempt” from further
review.) If yes, obtain signature from the Institutional Review Board Administrator (Anita Gordon):
___Human subjects approval was obtained on: __________________ (Date)
___Human subjects approval is pending. A protocol is currently under review by the IRB.
___A protocol will be submitted for human subjects review if this project is funded.
Signature:________________________________
Date:____________________
NO
YES Involve live vertebrate animals? If yes, contact the Office of Research and Sponsored Programs for
further evaluation.
NO
YES Propose new P&S or Merit employees? If yes, obtain signature from the Director of Human Resource
Services (Michelle Byers), or her designee.
Signature:________________________________
NO
YES Involve tuition or fees related to Continuing Education programs? If yes, obtain signature from the Dean
of Continuing Education and Special Programs (Kent Johnson), or his designee.
Signature:________________________________
NO
Date:_________________________
YES Involve any tuition that is 100% waived, whether General Fund tuition or Continuing Education tuition?
If yes, obtain signature from the Controller (Gary Shontz), or his designee.
Signature:________________________________
NO
Date:_________________________
YES Involve chemical or biohazardous waste such as recombinant DNA or RNA molecules, infectious agents,
toxins, human blood, unfixed human tissue, biohazardous microorganisms, chemical carcinogens,
pesticides, class III or IV lasers, radioactive or radiation producing materials, needs for room/lab
reconfiguration (additional hoods, power sources, etc.) or any other products or processes that may affect
the safety/health of University faculty, students or staff? If yes, obtain signature from the University
Safety Officer (Dean Shoars), or his designee.
Signature:________________________________
NO
Date:_________________________
Date:_________________________
YES Present any potential conflict of interest or financial disclosure; i.e. does it lead to any form of personal or
financial gain for project personnel or others closely associated with project personnel? If yes, the UNI
Financial Disclosure Form (http://www.uni.edu/policies/903) must be attached.
Revised 4/11/2012
NO
YES Result, either in the short term or long term, in the development of an original project or technology
other than a manuscript or report?
EXPORT CONTROLS
Please read carefully.
Does this proposal…
Involve activities that may be subject to export controls? If you answer “yes” to any of the following questions, contact
the Assistant Vice President for Sponsored Programs for more information as soon as possible.
NO
YES Does the sponsor forbid the participation of foreign nationals in the project?
NO
YES Will the sponsor have the right to review, approve or restrict the publication or other
disclosure of the research results?
NO
YES Will your project involve travel to, shipping to or working with individuals from a
sanctioned country (e.g. Balkans, Belarus, Burma, Cote d’Ivoire, Cuba, Democratic
Republic of Congo, Iran, Iraq, Liberia, North Korea, Sudan, Syria, or Zimbabwe (See
http://www.ustreas.gov/offices/enforcement/ofac/programs/ for a current list)?
NO
YES Will you travel to a foreign country with a laptop or GPS device?
NO
YES Will you ship equipment, chemicals, biological agents or data to a foreign country?
NO
YES Will your project involve equipment, software, chemical, bio-agent or technology that is
on the Munitions Control List, the Commodity Control List, designed or modified for
military use or use in outer space or there is reason to know it will be used for or in weapons
of mass destruction?
NO
YES Is the Program Announcement or Request for Proposals marked “Export Controlled”?
Revised 4/11/2012
3 of 4
ADMINISTRATIVE APPROVAL SIGNATURES
1) Primary Principal Investigator/Project Director Signature I certify that the information provided about this project
is accurate. Furthermore, I certify that I will direct this project in compliance with 1) UNI and RSP policies and
procedures, including conflict of interest, ethical standards in the conduct of research, intellectual property, and the use of
humans and animals in research, 2) the terms and conditions of UNI’s agreement with the sponsor, including submitting
all required technical reports and deliverables on a timely basis, and 3) all applicable laws and regulations. I also certify
that 1) I am not presently debarred or suspended, proposed for debarment, declared ineligible or voluntarily excluded from
receiving federal funds, 2) no federal funds were used for lobbying activities in connection with this proposal, 3) I am not
delinquent on any federal debt, and 4) the budget above represents the best estimate of full costs of the project and
identifies all sources of funds to cover full costs. I will be responsible for initiating and documenting allowable postaward project expenditures to include cost-sharing as well as sponsor funds.
Primary PI/PD: ___________________________________
Signature
________________________
_______________
Printed Name
Date
2) Primary PI’s Department Head’s and Dean’s or Division VP’s Signatures (Division VP signatures are required for
departments or organizational units that do not report to a College Dean. If the grant is to be assigned to a department other than
that of the Primary PI, signatures below should be that of the Department Head and Dean or Division VP of the organizational unit to
which the grant will be assigned. Attach additional sheets if necessary) We certify that we have reviewed the proposal and that
it is consistent with the mission of the department, the college or VP Division, and the University. We also certify that 1)
the technical merit of key personnel is sufficient to carry out proposed activities, 2) necessary resources for the project
including percent of investigator(s) effort (including teaching load reduction, faculty replacements, etc.), cost
sharing/matching funds, and space and/or facilities are committed and/or budgeted and that we are prepared to document
such commitments if required in the terms of the award or RSP policy and 3) all commitments of sustainability beyond
the grant period, proposed alterations to curriculum, and foreign exchange or travel is authorized.
Department Head of Primary PI/PD: __________________________ ________________________
Signature
Printed Name
Dean or Div. VIP of Primary PI/PD: __________________________ ________________________
Signature
Printed Name
____________
Date
____________
Date
3) Office of Research and Sponsored Programs (The Office of Research and Sponsored Programs is the last office to
sign this form.)
By my signature as UNI’s authorized institutional representative on grant and contract proposals and awards, I commit the
University to assuming the obligations imposed by Federal, State, and local laws, regulations, assurances, and compliance
certifications, and other sponsor imposed terms.
Signature:
___________________________________________
Date: ____________________
(RSP Use Only)
RSP Staff Person Assisting (if any):_____________________________________
Preliminary Proposal? NO YES
Type of Proposal (X):
_______Grant
_______Contract
_______Coop Agreement
_______Subaward (G,C, or CA)
Type of Submission (X):
_______New Project
_______Renewal
_______Continuation
_______Revision of Pending Proposal
Type of Activity (X):
______ Instruction/Training
_______Academic Support
_______Research
_______Public Service
_______Other: ____________________
_______Other: _____________________
_______Student Aid
_______Student Services
Revised 4/11/2012
_______Other: _____________________