Progress or Final Report
University of California Office of the President
SIGNATURE PAGE*
Special Research Programs
Form 1
(Check one)
Breast Cancer Research
Tobacco-Related Disease Research
AWARD NUMBER:
PROJECT PERIOD DATES from:
PROJECT YEAR (Check one):
to:
(Check one):
California HIV/AIDS Research
1st
2nd
Annual Progress Report
3rd
Final
Final Report
PRINCIPAL INVESTIGATOR(S):
PROJECT TITLE:
INSTITUTION:
ADDRESS:
TELEPHONE:
FAX:
E-MAIL:
WEB SITE:
PRINCIPAL INVESTIGATOR ASSURANCE: I certify that the statements in this report are true, complete**, and accurate to the best of my knowledge.
Signature of PI Named Above (In ink. “Per” signature not acceptable.)
Date
INSTITUTIONAL ASSURANCES: I certify that the statements in this report are true, complete**, and accurate to the best of my knowledge.
Signature of Contracts and Grants Official (In ink. “Per” signature not acceptable.)
Date
NAME/TITLE:
ADDRESS:
TELEPHONE:
FAX:
E-MAIL:
*For all Collaborative Grants, each PI must submit a separate copy of this page.
**A complete report includes Forms 1 thru 8, some with continuation pages. Both signatures must be present on this page. Enclose
renewals of vertebrate animal and human subjects approval documents, if needed.
Mail all forms to:
California Breast Cancer Research Program, Tobacco-Related Disease Research Program, or California HIV/AIDS Research Program
Special Research Programs • University of California • Office of the President • 300 Lakeside Drive, 6th Floor • Oakland, CA 94612-3550