Proposal Type
NEW ✔ SUP
RES
TRN
SOL
RFP
CON
REN
No.
MTA
Research
✔
Instruction
Mult. Submission?
Yes
TAMU-CC
Other:
Yes
Other #
No
If Yes, see below
Mail by
Prime Sponsor:
Title
Special Instructions
Questions:
2. Sponsor TRDF
TAMU #
X
TAMRF #
Federal Flow Thru
Scholarship/Fellowship
No
CFDA No.:
Public Service/Extension
Contract/Grant No.
1.
DOCUMENT REVIEW/APPROVAL
SHEET
(Internal Document Only)
Texas A&M System Part
Project Function
Year
Budget/Cost Sharing
N/A
2a. Sponsor Address
Phone
3.
Investigator(s) Information
Fax
E-mail
PI
E-mail
PI NAME:
COMPLETE AS APPROPRIATE
4. Human Subjects:
5. Lab Animals:
Species
Department
Sys Pt.
TAMUCC
X No
Yes
X No
24. Current Period
25. Duration
Recombinant DNA:
Yes
X No
7.
Conflict of Interest:
Yes
X No
8.
Infectious Biohazards:
Yes
X No
9.
Classified or Proprietary:
Yes
X No
10. Commercial Potential:
Yes
X No
11.
Yes
X No
Involved Nations
12. Scientific Diving:
Yes
No
13. Radioactive Material:
Yes
No
14. Involves University Faculty:
Yes
No
15. Use of University Facilities:
Yes
No
16. Renovations Required:
Yes
No
Phone
Ext.
COST SHARING INFORMATION
(Please attach cost sharing documentation)
BUDGET INFORMATION
Yes
6.
International Effort:
College
EMAIL:
to
33. Institutional Services:
$ Amount
Account Number
Yr(s)
Mo(s)
26. Total Sponsor Support:
$
27. Total F&A cost
$
N/A
28. Total F&A Cost Base:
$
N/A
28a.F&A Amount Waived
$
N/A
N/A
27a.F&A Rate: 0.00%
29. F&A Level
29. Level
30. F&A Justification
Subtotal Institutional Services:
31. Tuition
Status
30.
Justification
32. Tuition Justification
Official Use Only
ANNUAL REPORT CODES
$
34. External Sources:
$
(Name):
35. Total Project Cost (= #26 + #31 + #32)
$
33. PLANNED DISTRIBUTION OF SPONSOR FUNDS:
F&A COSTS
DIRECT COST (Expenditure Plan)
System Part
17. Activity
20. Character of Work a. Basic b. Applied
18. Field of Science
19. Area of Special Interest
$
$
21. Selection
$
$
22. Sponsor
$
$
23. LBB Requirement
$
$
$
$
0.00%
Page 2 of 2
Title
Total Sponsor Support: $
Sponsor
Approvals: There must be approvals from all department heads, deans, and/or directors whose personnel or facilities are involved in conducting the proposed work.
ATTN. INVESTIGATORS: Your signature below certifies, to the best of your knowledge and belief, that ...
a.) You are not delinquent on any Federal debt, such as student loans, etc. (this does not include income taxes); (applies to fellowships, scholarships, IPAs, etc. where
the implied recipient of funds is an individual vs. an organization; per A-110.22 and A-129.)
b.) You are not currently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from current transactions by Federal department
or agency; (per Executive Order 12549).
c.) You agree to accept responsibility for the scientific conduct of the project and to provide the required progress reports if an award is made as a result of this
application;
d.) You agree to comply with the TAMU Conflict of Interest Rule; (per NSF 60 FR 35820, 7/11/95; NIH 60 FR 35810, 7/11/95).
e.) You agree to comply with the TAMUS Policy on Ethics in Research and Scholarship, TAMUS #15.99.03.
f.) You agree to comply with the TAMUS Policy on Management of Intellectual Propoerty, TAMUS #17.02.01.
ATTN. DEPT. HEADS, DIRECTORS, DEANS:By your signature below you certify that you have reviewed this proposal and all accompanying forms; you are aware
of all requirements of this project and are committed to providing them, except as noted.
INVESTIGATOR(S)
1.
SIGNATURE
NAME/TITLE
DATE
2.
SIGNATURE
NAME/TITLE
DATE
3.
SIGNATURE
NAME/TITLE
DATE
4.
SIGNATURE
NAME/TITLE
DATE
5.
SIGNATURE
NAME/TITLE
DATE
DEPT. HEAD
DEAN
DIRECTOR/V. PRESIDENT