University of the District of Columbia Office of Sponsored Programs Proposal Routing Form Page 1

Proposal No. Document Type Agency Type

Proposal Purpose Proposal Status CFDA No.

Sponsoring Agency Sponsor's Deadline

Project Title

Principal Investigator(s)

Total project cost requested $ Yr.1$

Indirect Cost: $ On Campus Rate = 48% Off Campus Rate = 26% Other Rate: %

If other rate, please explain

No cost share/matching required Cost share/Matching required In-Kind:$ Cash:$

If cost share/matching is required, please complete the COST SHARE/MATCHING AUTHORIZATION FORM and provide a copy or website URL of the sponsor's guideline for cost sharing

Principal Investigator/Project Director's Statement Yes No1. Does the Proposal Involve Human Subject? If Yes, attach IRB Approval or Explain

2. Does the Proposal Involve DNA Techniques, Radioactive or hazardous materials or infectious agents, hazardous chemical waste? if yes, send copy of abstract to the University Wide Safety Committee

3. Is adequate space already assigned for the proposed program? if no, submit explanation to the Chairperson/Dean

4. Does the project provide for new academic degree program and or new courses?

5. Has faculty signed a University patent agreement? If no or uncertain, contact the Director of OSP

6. Is any proposed personnel presently debarred, suspended or proposed for debarment by any federal agency? If yes, proposal should contain explanation for each such person

7. Will project require as a condition of acceptance that the University absorb the services should project fund be reduced or terminated? If yes, please explain so that approval may be obtained in advance

8. Is there any out year commitment required or expected?

9. Is this a Public Health Services (PHS) Grant? If yes, attach "FCOI FORM"

Yr.2$ Yr.3:$ Yr.4$ Yr.5$

Department School/Division Phone Email

Consultant/Sub-Award/Subcontract Amount on the proposal Proposed Start Date

Proposed End Date

To prevent a delay in processing, all items requiring a routing form (proposals, agreements, contracts, MOUs, etc.) must be submitted to OSP first.

University of the District of Columbia Office of Sponsored Programs Proposal Routing Form Page 2

1. Explanation of Items from page 1. Add continuation page if needed

2. Faculty release time: Provide the names and departments of any faculty members for whom release time is requested. Indicate the amount of release time per academic year. List the amount of funds requested in this grant for release (salary and benefits) for the first year and the total grant.

Faculty Member's Name Department Release/Yr. $ Requested for Release Salary Yr.1

$ Requested for Release Benefits Yr.1

$ Requested for Release Salary Total

$ Requested for Release Benefits Total

Check here If more than five faculty are involved and include a continuation page. 2a. As Department Chair/Dean, I approve the proposed release time and agree to support any committed release not funded through the grant, using resources of my department/school/college (Continued on page 3).

Department Chairperson Signature Date

Title Name Signature DatePrincipal Investigator

Chair/Department Head

Dean

Chief CCDC OfficerDirector of Sponsored

ProgramsProcurement Director

General CounselChief Financial Officer

VP Human Resources

Chief Academic Officer

Statement of the Department Head and Dean or VP. This proposal is consistent with the educational and research objectives of the Department and University. I endorse its submission, and agree: (1). To abide by the approved budget as it relates to faculty and staff personnel. (2). That cost sharing, if proposed, is reasonable and appropriate for this program and available in my budget. (3). That adequate space will be made available for the proposed program.

University of the District of Columbia Office of Sponsored Programs Proposal Routing Form Page 3

School/College Dean Signature Date

3. Complete this section, if personnel in-kind or cash matching is requested:

Is matching required by the sponsor? Yes No

If yes, how much is required How much cash is required

From what budget(s) will the match be provided?

Name of approving person responsible for the budget Signature

How much In-Kind is requested (Value Description)

Availability of match has been verified. OCFO Date:

5. If Yes to question 8, please describe out year commitment and plan to fulfill it.

Proposals must arrive at the Office of Sponsored Programs a minimum of ten (10) days prior to the desired submission date.

4. Human Resources requirements:

4b.What is the scope of work to be provided:

Yes4a. Did you attach a detailed description of the staffing needs? Please provide details (e.g., position title and proposed salary) in the scope of work.

No

If the PI requires the development of or a change in their staffing plan, answer 4a-b. Otherwise, enter N/A in 4b.