STATE UNIVERSITY OF NEW YORK AT POTSDAM
INSTITUTIONAL REVIEW BOARD
Appendix C – Source(s) of Financial Support
Project #
Funding for this project has been requested or received from an internal or external funding source.
This project
has been
Funding for this project
will be
is pending
Is this a contract or sub-contract?
No
submitted to the following funding source.
has been funded
by the following funding source.
Yes, with whom:
Ex. If you have a grant/contract with Potsdam School District and they are funded by a State Agency – Potsdam
Central School District should be listed here. That is the party with whom you have a contract with.
Type of Original Funding Source:
Academic Department or Dean – Name:
Office of Research and Sponsored Programs
Corporate Sponsor – Name:
Foundation – Name:
State Agency – Name:
Federal Agency – Name:
Other – Name:
Contact person for the contract, sub-contract or grant:
Address:
Phone #:
E-mail:
Title of grant or contract(Ex. RF Award title):
Project Director/Principal Investigator:
Grant Number (ex. RF Award#):
Funding Period: from
to
The scope of work and/or work plan must be included, along with a time line of the
project.
Johanne Sullivan, Chair
Raymond Hall 204
Phone 267-2688
SUNYPotsdamIRB@potsdam.edu
Rev 1.24.14