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