University of Virginia -- Office of Sponsored Programs
Preliminary Account Request and Grant/Contract Change Request Form
Principal Investigator:
Org:
Award ID:
Sponsor:
Project ID:
Preparation Date:
Project Title:
SECTION A Changes only
I. Sponsor Approval Requested For:
Scope or Objective of Change
Establish Relatedness
No Cost Extension
Change or Absence of Principal Investigator
Foreign Travel
Other
Rebudgeting (Attaching a budget is required for all requests in this section)
II. Institutional Approval Requested For:
No Cost Extension to (date)
Pre Award Costs
Other
SECTION B Explanation/Justification (Briefly cite scientific, technical or administrative reason[s] for this request.)
SECTION C AT RISK Awards/Projects ONLY
New Award / New Project: (Oracle Supplemental Information Required)
New
Supplement
Same Award / New Project:
Renewal/Continuation - PTAO:
New
Supplement
Same Award / Same Project:
Renewal/Continuation - PTAO:
New
Renewal/Continuation - PTAO:
Supplement
Preliminary Projects:
Requesting “At Risk” be setup for the following dates __
__ to __
__ (if blank default is 6 mos.)
I HAVE received word from the sponsor concerning the continuation of the project.
I HAVE NOT received word from the sponsor concerning the continuation of the project.
Explanation:
NOTE: Should the project NOT be funded, the Dept Chair agrees to cover with local funds, under the control of the
department, all charges made to this AT RISK AWARD/PROJECT.
SECTION D Certification and Approvals
By signing below, the PI makes the following certifications: (1) that the information submitted is true, complete and accurate to the best of the PI's knowledge; (2)
that any false, fictitious, or fraudulent statements or claims may subject the PI to criminal, civil, or administrative penal ties; and (3) that the PI agrees to accept
responsibility for the scientific conduct of the project and to provide the req uired progress reports, as applicable.
Principal Investigator
Date
Department Chair
Date
Research Administrator
Date
Institutional Official
Date
07/29/2010 SP23-R