University of La Verne s1

University of La Verne Proposal Cover Sheet (Please complete form in its entirety, obtain all signatures as noted, attach budget, proposal summary, support documents.)

1. Principal Investigator:

Last Name First Name Academic Discipline E-mail Address ULV Extension

2. Proposal Identification/Title:______

3. Administering Department:______

Program No. Object Code Contact Person E-mail Address ULV Extension

4. Granting Agency Name: ______Agency Address: ______Application Due Date:______Project Begin Date:______Project End Date:______

5. Proposal Type: □ Grant □ Contract □ Subcontract □ Coop Agreement □ Clinical Trial Award will be: □ New □ Continuation □ Renewal □ Supplement □ Revision Project is: □ Research □ Training □ Equipment □ Fellowship/Sabbatical Sponsorship ULV research type: □ Applied □ Basic □ Development □ Other ______

6. Proposed Budget Summary (See www.ulv.edu/grantassist/pdf/budget_plan_worksheet.xls for assistance in determining these figures). Please attach copies of worksheets as Attachment 1:

Total Agency Total Project Matching Budget Summary Direct Costs Indirect Costs In-Kind Cash Request Amount Funds Initial Project Year Total Project Period (multi- year projects) Indirect Cost Rate:______% (explain how indirect is calculated)______Direct Costs (on basis of personnel/explain)______Source of Cash Matching Funds:______In-kind details (provide Attachment 2) approval initials: Dean:______Provost/VPAA:______7. Participants in Research:  Humans will not be used in research  Animals will not be used in research  Humans will be used in research IRB approval date:______ Animals will be used in research IACUC approval date:______8. Conflict of Interest Statement:  There is no potential conflict of interest.  There is a potential conflict of interest (plans for resolution, provide Attachment 3). 9. Departmental Approvals:

______Department Chair (if applicable) Date Principal Investigator Date ______College Development Director (if applicable) Date Dean Date

10. Administrative Approvals:

______Associate Vice President for Finance Date Provost/Vice President for Academic Affairs Date

______Associate Vice President and Treasurer Date Manager of Grant and Foundation Support, University Relations Date