Bemidji State University
Review for External Funding Requests
(For use with requests for outside funding from government or independent sources.)
INTERNAL DEADLINE: The deadline for submission to the Respective Vice President’s office is one week before the
grant needs to be sent from campus.
SIGNATURES: The Proposer obtains the chair’s, the dean’s/supervisor’s, and the grant officer’s signatures. If the
document is then delivered to the Respective Vice President’s office one week (five full work days) in advance of the grant
deadline, the Respective Vice President’s office will be responsible for obtaining the remaining signatures. If the proposal
is submitted later than one week in advance of the deadline, the Principal Investigator/Proposer must obtain the
signatures. It is the Proposer’s responsibility to retrieve and submit the grant to meet grant deadlines.
Proposal and Contact Information
Today’s Date
Proposed Title
Short Description:
Principal Investigator(s)/Proposer(s)
Date to Submit Deadline
Principal Investigator's Telephone Number/Location
Department Name(s)
College Name(s)
Please indicate what type of proposal this is: ____________research ___________teaching ___________service
Project Beginning Date
and Ending Date
External Funding Sources
Amount of Direct Funds being requested from grantor
Amount of Indirect Funds being requested from grantor
33.4% federal
8% non-federal (minimum)
If the indirect funds being requested are neither of the percentages listed above, please attach approval from
William Maki.
Name of Primary Agency
Mailing Address of Primary Agency
Please identify all partners to grant
University Funding Source
Are University matching funds required?
YES
NO
If “YES”, does match require dollars or in-kind? DOLLARS (Amt.
) IN-KIND (Amt.
)
If “YES”, please indicate the source of funds? __________approved college budget __________department budget
__________summer school profits __________other grant funds __________other (specify)
If this proposal is funded (Answer all questions):
Will any additional University space be required? (Where? Identify.)
YES NO
Will facilities modifications for laboratories, computer technology, etc. be required?
YES NO
Will re-assigned time for faculty or staff be required? (What %?
)
YES NO
If yes, please indicate if cost is covered by external funding source
Will human subjects be involved? (Date of Review
Outcome
)
YES NO
Will animal subjects be involved? (Date of Review
Outcome
)
YES NO
Will hazardous materials be involved? (Date of Review
Outcome
)
YES NO
If “YES” to any of these items, please elaborate (use additional sheet if necessary):
"The information on this form is complete, accurate and fairly represents the intent and scope of this proposal.”
Signature of Principal Investigator/Proposer
Date
Chair’s Signature
Date
Dean’s/Supervisor’s Signature
Date
Signature of Grants Accounting Officer (Dennis Burgess)
Date
**The following signatures will be secured by the Respective Vice President’s office provided proposals are
presented to that office at least one week (five full work days) in advance of the grant deadline. If the proposal is
not received one week in advance, the Principal Investigator/Proposer will be responsible for circulating the
document to the appropriate offices.
Signature of Vice President for Finance and Administration **
Date
Signature of Provost & Vice President for Academic Affairs** or
Signature of Vice President for Student Development and Enrollment
Date
Signature of the President **
Date
(The fully-signed form is returned to Dennis Burgess and kept on file in the Grants Accounting Office. Blank forms can be
found in the Grants Accounting Office, Deputy 201B, and the Academic Affairs Office, Deputy 305, as well as online on the
Academic Affairs web site at http://www.bemidjistate.edu/academics/affairs/forms.html. Please print this form on green
paper.)
Revised 10/07