American University | Office of Sponsored Programs | Routing and PI Assurance Form
OSP Proposal #
PI:
Dept./School/College:
Sponsor:
Funding Agency (If different from sponsor):
Project Title:
Proposal Type:
New
Revision*-* If checked, OSP will complete only the top portion of this form and will attach the Revised Proposal Form
Supplemental**
Continuation** - **If checked, please provide existing internal AU account #:
Proposal Project Period: Start Date:
End Date:
This section to be completed by the PI
1. The proposed project will require
8.
new space or alternation of existing space
hiring of new personnel
purchase of new equipment
If you checked any item above, please explain below and indicate if
such will be accommodated with funds requested by the sponsor.
Have equipment costs been cleared with Purchasing?
Yes No If yes, please attach the quote.
2. Will you be requesting a course release?
Yes No
3. Does the proposal involve the creation of or planning for a new
degree program or degree track? Yes No
If yes, please describe.
4. Does the proposal involve the use of consultants or
subcontracts?
Yes
No
If more than 50% of the funding is going to another organization,
please explain why AU is taking the lead.
Please check if this project involves any of the following:
Human Subjects:
Protocol Status: pending exempt approved
(approval number)
Vertebrate Animals:
Protocol Status: pending exempt approved
(approval number)
Use of Radioactive Materials
Use of Bio hazardous Material
Use of Infectious Agents
9. Does the project involve work with special insurance, or work
overseas? Yes No
Will the program be intended for minors (ie: Summer Camp)?
Yes No
If yes, list the date of coordination with the Risk Management and
Safety Office. For overseas projects, attach the country risk report
from the Office of Risk Management.
10. What level of academic year effort (per percent) will be
required by the PI and Co-PI to conduct the proposed project?
PI
5. Does the proposal include funds or contributions in the form of:
Cost-Share:
Yes
No
Matching:
Yes
No
If yes, is cost share or matching required by the sponsor Yes No
Please note: Proposed cost share should be included in the internal
budget and acknowledgement from your Department Chair, Dean or
designee in the form of an e-mail or other communication is required
and should be attached when the proposal is routed for
review/approval.
6. Does this proposal contain any information which is:
Patentable, Confidential, Copyrightable, Proprietary?
Yes No
If yes, please indicate via page number(s) where this information is
located in the proposal.
Will this project involve intellectual property in which you or
the University may own or have an interest?
Yes No
7. Indicate the type of research/program to be conducted:
(Hover cursor over checkbox for definition)
Basic Applied Developmental
AY
Summer
AY
Co-PI
Summer
Year 1
Year 2
Year 3
Year 4
Year 5
Will salary support be requested from the sponsor to fully
reimburse the level of proposed effort above? Yes No
(If no, voluntary cost share is proposed and question #5 is applicable.)
11. Will the project involve payment to foreign nationals?
Yes
No
12. If applicable, indicate where the funding opportunity for the
project/program that you are applying for was obtained:
Pivot Grant Forward SciVal Foundation Center
OSP Newsletter OSP Staff Provost Office
Other:
13. Will the proposed sponsored project/program take place in any
of the following:
Provide a brief abstract of the proposal (REQUIRED). There is a 600 character limit. Attach additional sheet if needed.
I certify that the information provided in the routing form and in the application/proposal is true, complete and correct to the best of my knowledge.
I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties.
I understand as the Principal Investigator, I have ultimate responsibility for the scientific conduct of the proposed project, the ethical performance of the proposed project, the
protection of the rights and welfare of human subjects, and adherence to any stipulations imposed by the applicable IRB and/or IACUC. I accept responsibility for compliance with
all applicable regulations, laws, and polices of the sponsor and American University, including those governing the use of space, salary verification, cost sharing and financial
oversight of the proposed project. I understand I must notify American University of any change of information provided in the routing form or application/proposal, but not
limited to, changes in the project scope.