University of Kansas Medical Center Research Institute

University of Kansas Medical Center Research Institute PROPOSAL ROUTING SHEET FOR NON-COMPETING RENEWALS/CONTINUATIONS (Progress Report)

DEADLINE: Date/Time Received______SPA Proposal #_

PROJECT PERIOD: FROM TO Continuation/Supplement to Acct # Principal Investigator (Last Name, First Name) Contact Name/Phone# E-Mail Address

PI's Department Administering Dept/Center (F&A Return Dept/Center)

Project Location (Room and Building) KUMC Centers Related Select:

Project Title:

Funding Agency/Institution Original Source of Funding (if KUMC is the subcontractor)

Does the progress report include Cost Sharing or Matching Funds? No Yes (Attach Chairs, Dean’s or Ctr. Director’s Letter of Commitment if there has been a change) Does the progress report include a Subcontractor? No Yes

Key Personnel: Name Department Name Project Role EFFORT COMMITTED Cost Share Effort Original Effort Changed To (if appliccable)

Add additional page for key personnel not listed above

IF YOUR RESEARCH INCLUDES HUMAN SUBJECTS OR VERTEBRATE ANIMALS, INCLUDE AN UPDATED COPY OF IRB OR IACUC APPROVAL AS APPROPRIATE YES NO Select Agents KUMC Safety Forms YES NO Human Tissues/Body Fluids IRB# or not Human Subject Determination YES NO Recombinant DNA Approval Date KUMC Safety Forms YES NO Radioisotopes/Radiation Produce Equipment Approval Date KUMC Safety Forms YES NO Biohazards / Hazardous Materials (if yes, attach approval form) KUMC Safety Forms YES NO Stem Cells IF YES: Adult Umbilical Somatic Cell Nuclear Transfer Mouse Embryonic Other Human Embryonic: approved cell line number/Source or / __ i.e. WA01/WiCell

______PI/Project Director’s Signature/ Date Dept. Admin. Initials Co-PI’s (if applicable) Signature / Date

(Please add additional signature page for multiple PI’s/Co-PI’s project) DEPARTMENT/CENTER CHAIR: The attached application is approved. It is within the total program and academic objectives of the Department/Institution/Center. Adequate space is available or planned for the conduct of the project. The professional time allocations described therein are approved.

______Department Chair/Center Director (typed/written) Department Chair’s/Center Director’s Signature

______Collaborating Dept. Chair (typed/written) Collaborating Dept. Chair’s Signature

KUMC Research Official Signature ______Director, Sponsored Programs Administration

SPA Rev. 10-17