Please note: The Grant Data Form and proposal are due for review and signatures at least 4 days prior to the submission of the proposal.
F-
CSU, Northridge-Grant Data Form (GDF)
-
FROM
DATE
NAME OF PRINCIPAL INVESTIGATOR(S)
P.I. EXTENSION
EMAIL ADDRESS
DEPT(S)
EXT.
NAME(S) TO APPEAR IN ANNOUNCEMENT IF AWARDED
CONFLICT OF INTEREST FORM COMPLETED
COLLEGE(S)
Same as above
YES
NO
OTHER (specify)
(if no please contact Research & Sponsored Projects x2901)
TITLE OF PROPOSAL
AGENCY NAME
ELECTRONIC SUBMISSION
(e.g., grants.gov, Fastlane, e-grants)
AGENCY ADDRESS
NAME AND ADDRESS OF AGENCY REPRESENTATIVE
AGENCY TYPE
FEDERAL
STATE
LOCAL
(N/A for Electronic Submission)
FOUNDATION
PERIOD COVERED BY REQUEST
CORPORATION
IF PAPER SUBMISSION,
NUMBER OF COPIES TO SEND,
INCLUDING ORIGINAL
OTHER NON-GOVT.
THROUGH
DATE
APPLICATION IS
NEW
DATE
CONTINUATION
OTHER (Specify)
F & A* RATE (%)
DIRECT COSTS $
+ F & A COSTS $
= TOTAL REQUEST $
YES
If you answer YES to any questions, use second page to explain. Please respond to every item.
NO
1. Are F & A (indirect) costs reimbursed at LESS than University rates?
2. Do the PROPOSAL GUIDELINES REQUIRE matching or cost sharing from the University (either cash or in-kind)?
3. Does the proposal provide OVERTIME compensation for project personnel during acad. year? If YES, Faculty Workload Form required.
4. Will project personnel be released from teaching at any point during the project?**
5. Will the project require renovation of existing space or the use of space in addition to that which is currently available to you? If YES,
indicate square footage:
6. Will the project employ students? If YES, indicate the number and level.
Graduate
_
Undergraduate
7. Will the project require expenditure of work-study funds?
8. Are safety considerations, e.g., radiation, carcinogens, mutagens, infectious diseases, recomb. DNA or hazardous materials involved?
9. Will proposed work require modifications to curriculum?
10. Are HUMANS involved as experimental subjects? If YES, specify status of IRB approval on second page.
11a. Are ANIMALS involved as experimental subjects? If YES, specify status of IACUC approval on second page. If you answered NO,
please also check NO on 11b.
11b. If you answered YES to 11a, does the proposal request funds for animal care and housing? If the proposal does not request funds for
animal care and housing, please indicate source of funds for animal care and housing on second page.
**UNIVERSITY COMMITMENTS OF RELEASED TIME ARE CONTINGENT UPON THE AVAILABILITY OF FUNDS
IT SHOULD BE UNDERSTOOD THAT THE APPROVALS GIVEN ON THIS FORM REPRESENT GENERAL APPROVAL OF TECHNICAL MERIT,
ALLOCATION OF UNIVERSITY RESOURCES AND FINANCIAL BUDGETING, BUT DO NOT REPRESENT SPECIFIC APPROVAL OF PERSONNEL TITLE
CLASSIFICATIONS OR SALARY RATES. THESE ARE EXPECTED TO CONFORM TO UNIVERSITY PERSONNEL POLICIES AND PROCEDURES
INCLUDING, BUT NOT LIMITED TO, CLASSIFICATION, JOB DESCRIPTION, SALARY AND AFFIRMATIVE ACTION REQUIREMENTS.
Signed
Date
Signed
Principal Investigator or Director
Date
Co-P.I. or Director
Signed
Date
Signed
Co-P.I. or Director
Date
Co-P.I. or Director
NOTE: SIGNATURES BELOW REPRESENT APPROVAL OF THIS PROJECT, INCLUDING AGREEMENT TO ACCEPT A REDUCED F & A COST
RECOVERY (IF APPLICABLE). IF FACULTY FROM MULTIPLE DEPARTMENTS AND/OR COLLEGES ARE INVOLVED, RELEVANT DEANS AND
CHAIRS MUST SIGN. USE ADDITIONAL SIGNATURE SPACE PROVIDED ON BACK IF NECESSARY.
Department Chair(s)
/
Date
College Dean(s)
/
Date
CFO
Date
Other
Date
Director of Research &Sponsored Projects
Date
*Indirect Costs are referred to as Facilities and Administration (F & A) costs by most granting agencies and are synonymous terms.
Revised on 4/23/09
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Please note: The Grant Data Form and proposal are due for review and signatures at least 4 days prior to the submission of the proposal.
CSU, Northridge-Grant Data Form (GDF)
If you checked YES to any questions, #1 through #11b on page one, use this space to provide explanations. Please identify each
answer by the corresponding question number.
Additional Signature(s)
/
Date ______________________
If you checked YES to questions 10 or 11a on page 1, please complete the appropriate information below:
Human Subjects Review:
Approval Obtained
Protocol Submitted
Date
Animal Subjects Review:
Approval Obtained
Submission Pending
Date
Protocol Submitted
Date
Submission Pending
Date
ABSTRACT OF PROPOSED WORK (for answering inquiries, announcing grant and contract awards and possible inclusion in compilations of
information on research and sponsored programs). The summary should express the purpose and the essential elements of the proposed activity, but
should be written in terms that can be understood by a non-specialist.
Type of Proposal:
RESEARCH
TRAINING
EQUIPMENT
CLINIC/SHORT COURSE
OTHER
(Specify)
DIRECTIONS
Complete this form and forward to Research and Sponsored Projects, University Hall 265, after obtaining required signatures.
NOTE: This form must be on file, with required signatures, prior to the proposal's submission to the funding agency for consideration.
Revised on 4/23/09
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