American University | Office of Sponsored Programs
Routing and PI Assurance Form
OSP Proposal #
PI:
Sponsor:
Proposal Type:
Project Title:
New
Proposal Project Period:
1.
2.
3.
Dept./School/College:
Supplemental*
Continuation*
Revision*
Start Date:
The proposed project will require
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.
Will you be requesting a course release? yes no
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.
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 email or other communication is required and should be
attached when the proposal is routed for review/approval.
*Reference Contract or Grant Number:
End Date:
7.
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
8.
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.
9.
What level of effort (per percent) will be required to
conduct the proposed project?
Year 1
Year 2
Year 3
.
Wh
Wh
Year 4 at
Year 5 at
Wh
Will
be requested from
Whsalary support Wh
levethe sponsor to fully
at
leve
reimburse
the levelat
of
proposed
effort?
Yes No
at
l of
leve
l of
(If lleve
no,
share is proposed
leve
effoand question #5 is
of voluntary cost
effo
applicable.)
l of
l of
rt
effo
rt
10. Will
the project involve
payment to (per
foreign nationals?
effo
effo
rt
(per
yes
no
rt
rt
6. Does this proposal contain any information which is:
perc
(per
perc
(per a brief (max
(per
Patentable, Confidential, Copyrightable, Proprietary?
11. Include
500 character) ent)
abstract. Attach
perc
ent)
perc
additional
sheets aswill
necessary.
Yes No
perc
will
ent)
ent)
If yes, please indicate via page number(s) where this
ent)
be
will
be
will
information is located in the proposal.
will
req
be
req
be
be
uire
req
uire
Will this project involve intellectual property in which you
req
req
d to
uire
d to
or the University may own or have an interest?
uire
con
duire
to
con
Yes No
d to
d to
duc
con
duc
con
t
duc
tcon
duc
the
tduc
the
t
tpro
pro
the
I certify that the information provided in the routing form and in the application/proposal is true,pro
complete and correct
the
the
posknowledge.
pos to the best of my
I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal,
penalties. ed
procivil, or administrative
pro
pos
ed
I understand as the Principal Investigator, I have ultimate responsibility for the scientific conduct ed
of the proposed project,
of the
pos
pos
proj
proj the ethical performance
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
ed
ed
ect?
proj
ect?
accept responsibility for compliance with all applicable regulations, laws, and polices of the sponsor
and
American
University,
including
those
governing
the use
proj
proj
ect?
of space, salary verification, cost sharing and financial oversight of the proposed project. I understand
American University of any change of
ect? I must notify ect?
information provided in the routing form or application/proposal, but not limited to, changes in the project scope.