Transmittal Form for
External Grants and
Contracts
(Internal Use Only)
PLEASE ROUTE TRANSMITTAL FORM & COPY OF YOUR PROPOSAL TO RSP
OFFICE & ALLOW RSP OFFICE A MINIMUM OF 4 WORKING DAYS FOR PROCESSING
1. Proposal Title:
2. Principal Investigator: Name – Dept./Unit/Center – School/College
3. Co-Investigator(s): Name – Dept./Unit/Center – School/College – (Co-PIs share the return on indirects and
must be SCSU employees)
4. Collaborations, applicable for projects with more than one PI:
None
Intradisciplinary Project (within a dept.)
Interdisciplinary Project (between depts. )
Intercollege Project (between schools/colleges)
University-wide Project
5. Other Participant(s):
6. Funding Agency:
Contact Person:
Address:
Phone:
Fax:
7. Agency Type:
Email:
Business
Federal
Federal Flow-through
Other Government
MnSCU
State
Foundation
Other Non-Government
8. Today's date:
Proposal due date:
9. Project begin and end dates:
10. Type of Proposal:
to
Grant (competitive)
Cash
In-Kind
(pick one)
Contract (negotiated)
Cash
In-Kind
(pick one)
Office of Research & Sponsored Programs Use Only – AS 210
Award Status:  Awarded  Denied
Award Date:
Start Date:
End Date: 
Revised 7/17/14
 Yes  No
IACUC:  Yes  No
RCR:  Yes  No
FCOI:  Yes  No
FFATA:  Yes  No
T & E:  Yes  No
IRB:
Account #:
Award Amount: 
Agency Award #: 
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Proposal Budget and University’s Financial Commitment
11. Total funds requested from funding agency: $
12. Indirect cost rate included in budget:
%
Federal rate: 33.4% of modified total direct costs (see rate agreement for more information: http://osp.stcloudstate.edu/indirect_costs.htm);
Non-Federal rate is 12% of total direct costs.
13. Does the project require a variance on the University’s indirect cost recovery policy?
Yes
No
In accordance with Minnesota Statute 16A.127, SCSU requires indirect cost recovery on all externally funded activity. Variances are allowable only
when indirect costs are limited or disallowed by the funding agency. SCSU reserves the right to reject any proposal that does not include indirect costs.
Please justify the variance and attach documentation:
14. Does the project include a cash (hard) match?
If yes, amount:
Is the match required by the funding agency?
Yes
No
Yes
No
Yes
No
Yes
No
Who and which account will supply the cash match?
(Responsible person for match $ initial
)
15. Does the project include a soft (in-kind) match? If yes, cash value:
Is the match required by the funding agency?
Specify type and source of soft match (e.g. personnel, supplies, equipment, facility use, etc.)
(Responsible person initial here
)
Reminder: Documentation is required for all cost shared items on federal grants (i.e. receipts, time logs, etc.)
Ethics and Compliance
16. Plagiarism: I hereby acknowledge this proposal or any sections within the proposal is not plagiarized.
The source is cited for information taken from other’s research and copied text is identified via quotation
marks or indentation, including SCSU institutional descriptions. Unless the source is cited, I have obtained
the written consent from the original author(s) to use the text
17. IRB (Institutional Review Board): Does your project involve research with human subjects?
Yes
No
Yes
No
Yes
No
Yes
No
If yes, PI’s responsibility to submit for review. Provide approval # or submission date:
18. IACUC (Institutional Animal Care and Use Committee): Does your project involve research using animals?
If yes, PI’s responsibility to submit for review. Provide approval # or submission date:
19. RCR (Responsible Conduct of Research): Does your project include compensation for undergraduate,
graduate and/or post-doc students?
Note: RCR training maybe required. See website for more info: http://stcloudstate.edu/osp/policies/conduct.asp
20. FCOI (Financial Conflict of Interest): Related to this project or its funding, do you or any key personnel have a
financial interest or any personal beneficial interest directly or indirectly in contracts or purchase orders
for goods or services? A financial interest includes salary or any other payments for services, equity
interests, IP rights, or financial interest in any entity whose financial interests would reasonably appear
to be affected by the research. This applies to you, your immediate family, your partner or an organization
which employs or is about to employ any of these parties.
Yes
No
Yes
No
Yes
No
21. FFATA (Federal Funding Accountability and Transparency Act): Will any vendors be paid $25,000 or more for
work pertaining to this project?
22. T&E (Time & Effort Reporting): Will there be any special personnel arrangements related to project?
(e.g. professional overload, graduate assistantships, reassigned time, etc. for any SCSU employees)
Please explain:
Revised 7/17/14
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23. Export Controls: Export Controls may apply to projects that involve transactions with an inherently military use or
transfers of items of “dual-use” (commercial or military).
- Related to this grant or contract, does your project involve inherently military technologies related
to electronic equipment, systems, software, explosives, toxicological agents, radiological equipment,
Yes
No
encryption technology, composite materials, lasers, navigation equipment or similar items?
Yes
No
- If “yes” to either, are there restrictions placed on any publication which may arise from this research?
Yes
No
spacecraft systems or similar items?
- Does it involve “dual-use” items with a potential military application related to high-end computers,
Institutional Acknowledgements
24. Are you currently delinquent on any Federal debt, debarred or suspended from receiving Federal assistance?
Yes
No
25. I authorize RSP to share this proposal with others for the benefit of SCSU. (can deny without consequences)
Yes
No
26. Does this project require special use of campus facilities (e.g. science/computer labs, dance studio, etc.)?
Yes
No
Yes
No
If yes, explain:
27. Does this project require changes in physical arrangements?
If yes, attach approval document from SCSU Buildings and Grounds.
28. I hereby acknowledge allowing work to begin on an externally-funded project without a fully-executed
agreement in place is a violation of Minnesota Statute 16A.15, Subd. 3.
Yes
29. Upon award, I authorize the following individual(s) access to my account to assist with purchasing and/or student payroll
associated to my award (check all that apply)
FULL ACCESS:
Lorie Ortloff (post-award for HBS, SoPA, SHHS)
Purchasing (PCS)
Payroll
Deb Rothstein (post-award for COSE)
Purchasing (PCS)
Payroll
Other (Office Manager or Others) _____________________________
Purchasing (PCS)
Payroll
None
30. Describe new course or curriculum changes to be developed as a part of the project:
SIGNATURES OBTAINED BY PRINCIPAL INVESTIGATOR:
I have read the proposal referenced above and agree to its submission under the conditions stated. I understand the use of all
external funding, regardless of source, is governed by State of MN regulations and MnSCU procedures and that grants and
contracts are awarded to the institution, not to individuals. As Principal Investigator (PI), I will be responsible for proper
management and spending of funds associated with the project(s) funded.
_______________________________________________________________________________________________
Principal Investigator Signature attests acceptance of academic and administrative responsibilities
Date
_______________________________________________________________________________________________
Department Chair(s) or Center/Unit Director(s) Signature authorizes use of dept. resources as
Date
described in items 14,15, 22,26 & 27
_______________________________________________________________________________________________
School/College Dean(s) or Vice President (s) Signature authorizes use of college resources as
Date
described in items 14,15, 22, 26 & 27 and attests to supervisory responsibility of the PI in executing the
grant or contract activity.
Revised 7/17/14
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SIGNATURES OBTAINED BY RESEARCH & SPONSORED PROGRAMS:
I approve submission of the proposal under the conditions stated.
______________________
RSP Director Final Approval
_______________________________________________________________________________________________
Associate Provost for Research
Date
_______________________________________________________________________________________________
Provost and Vice President of Academic Affairs
Date
Revised 7/17/14
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