Northern Illinois University
Action Request Form
Principal Investigator (PI): Click here to enter text.
PI Department: Click here to enter text.
OSP File #: Click here to enter text.
GFA Grant Account #: Click here to enter text.
Sponsor: Click here to enter text.
Sponsor Award #: Click here to enter text.
Project Title: Click here to enter text.
No-cost extension
Project Scope Change
Rebudget/Carryforward/Cost-related Changes
Key personnel change
Current Project End Date: Click here to enter a date.
Transfer of Award
Other (Specify under Justification )
Requested New End Date: Click here to enter a date.
(Complete for no-cost extensions and key personnel changes)
Will any of the proposed changes result in a significant (>25%) change or decrease in effort?
If YES , complete the table below and provide rationale for the effort reduction in the Justification .
Name
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Click here to enter text.
Role
Current Effort
(shown as a %)
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Proposed Effort
(shown as a %)
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Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
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Projected account unobligated balance at the end of the current period
(if unsure, please contact your GFA administrator for this information) :
$
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Click here to enter text.
Are all research compliance protocols approved and current? List protocol #’s and expiration dates. If expiration is before new end date, enter next proposed submission date.
Protocol # Expiration Date
Human Participants (IRB): Click here to enter text.
Click here to enter a date.
Animal Use (IACUC): Click here to enter text.
Click here to enter a date.
Next Proposed Submission
Click here to enter a date.
Click here to enter a date.
Biosafety: Click here to enter text.
Click here to enter a date.
Click here to enter a date.
Please summarize why the above action(s) needs to be taken and how it relates directly to the project referenced above. For no cost extensions, indicate: 1) the reason why the work was not completed during the approved project period and 2) what work will be completed during the extension period. Reminder: extensions may be requested for programmatic reasons only and to complete the approved scope of work.
Enter text here
Continue justification on page 2, if needed.
Version #4 02/14
Office of Sponsored Projects Grants Fiscal Administration http://www.osp.niu.edu/osp/index.shtml
http://www.niu.edu/GrantsFiscal/
815-753-1581 Fax: 815-753-1631 815-753-1576 Fax: 815-753-6081

(to be obtained by the Principal Investigator)
Northern Illinois University
Action Request Form
Principal Investigator ^
^If PI is Department Chair/Unit Director, Asst Chair/Director or other Proxy should sign under Chair/Director.
Date
Departmental Chair/Unit Director Date
Grants Fiscal Administration Date
* The NIU Grants and Contracts Administrator is authorized to approve costrelated changes that may be made in accordance with CFR § 215.25.
Office of Sponsored Projects Date
If sponsor approval is required, attach the letter request to this form with a signature block for AOR countersignature. See letter template at
OSP & University Policies - NIU - Sponsored Projects
Version #4 02/14
Office of Sponsored Projects Grants Fiscal Administration http://www.osp.niu.edu/osp/index.shtml
http://www.niu.edu/GrantsFiscal/
815-753-1581 Fax: 815-753-1631 815-753-1576 Fax: 815-753-6081