INTERNAL ROUTING (SHORT) FORM
*Sponsored Programs*
SUBJECT: Check ONE only.
___ Material Transfer Agreement (MTA)
Identify material or license:
____ License Agreement
___ Memorandum of Understanding (MOU)
____ Other (Please specify: _________________________)
Project Title (if applicable):
<NOTE: insert important details or special provisions that need special attention>
Researcher Certification: My signature below certifies that 1) I agree to be bound by the terms and
conditions of the attached agreement which supports the proposed activity; 2) I agree to abide by the
University’s research policies, including UPS 630.000 (scientific misconduct), UPS 620.000 (human
participants), UPS 610.000 (conflict of interest) and UPS 100.005 (patents); 3) my time commitments for this
and other externally funded projects does not exceed 125% of my time during the academic year per CSU
Policy, HR 2002-05, dated February 19, 2002; and 4) I further certify that I am not currently debarred or
suspended from receiving federal or state assistance and that I am not delinquent in repaying debts to the
federal government. Lastly, I certify that I am aware of the federal regulations regarding Lobbying and DrugFree Workplaces and will comply as necessary.
Researcher’s Signature: _________________________________ Date: _______
Printed Name:
Department:
University Approvals: I approve the attached agreement and certify that the proposed project can be completed within
my area of responsibility, within the space, financial, personnel resources and time limits available at this time. I have
read the terms and conditions of the agreement and approve of the commitments expected of my unit.
Department Chair Signature: _____________________________________
Printed Name:
Date:
Dean/Unit/Division Head: ______________________________________
Date:
AVP-RCATT:
Date:
<add additional approvers – for example, Risk Management, IT Security Officer, etc., as appropriate>
Enclosure(s):
FY 2015-16 (vFeb2016)