Request for Proposal Approval and Submission (Checklist)

University of Hartford Office of Sponsored Programs

Proposal Summary PROPOSAL # ______(ProSum) 1. Principal Investigator(s) DUE DATE: PI Name: Email: Extension: Co-PI Name: Email: Extension: 2. Administering College College name: College org number: College contact name: Email address: Ext.: 3. Administering Department Dept. name: Dept. org number: Grant Administrator: Email address: Ext.: 4. Proposal Identification Proposal Title: Current Contract or Grant No. (if applicable): Project Start Date: Project End Date: 5. Funding Agency Information Agency Name: Agency Contact: Agency Address: Contact Phone: Contact Email: Are there Federal Pass through funds? If yes, from what agency? 6. Proposal Information (check all that apply) Type: Grant Contract Subcontract Cooperative Agreement New Continuation Renewal Supplement Fellowship 7. Proposal Checklist Yes No On Campus Space. Indicate building and room(s). If no, indicate off-campus space arrangements. BioChem building. Will any this project take place in the BioChem building in the ISET complex? ______% Compensation. Will any University of Hartford personnel receive compensation in excess of their base pay? If yes, state who ______Course Release(s). If yes, indicate how many. Conflict of Interest. Whether there is a conflict or not, attach the University Conflict of Interest form. Subcontracts. If yes, attach a copy of the subcontractor’s proposal and budget. If yes, are subcontractors on Federal list of excluded parties (see http://epls.arnet.gov/)? yes no Consultants. If yes, attach a list of consultants. If yes, are consultants on Federal list of excluded parties (see http://epls.arnet.gov/)? yes no Human Subjects. If yes, attach approval from the Human Subjects Committee (HSC). Animal Subjects. If yes, attach approval from the Institutional Animal Care and Use Committee (IACUC). Private Sponsor. If yes, is the original source of the funding Federal? Explain. Request for Proposal. If this proposal is in response to a formal RFP, attach the RFP. Multiple Departments. If yes, indicate departments involved. Matching Funds (incl. in-kind). If yes, attach budget and justification for match/in-kind. Include source(s) of funds. If yes, total Match/In-kind: $ Reporting. Are your reports on existing grants current? If no, attach a list with reports due and expected completion. 8. Funds Requested for all Budget Periods Total Request: $ Yr 1 Tot.: $ Yr 2 Tot.: $ Yr 3 Tot.: $ Yr 4 Tot.: $ Total Direct: $ Direct: $ Direct: $ Direct: $ Direct: $ Total Indirect: $ Indirect: $ Indirect: $ Indirect: $ Indirect: $ Indirect Rate (check one): 42.3% of salary/wages 10% of total direct Other, please specify rate: 9. Brief Summary of Project

10. Approvals

(1) Principal Investigator Date (2) Co-Principal Investigator Date

(3) Dean Date (4) Other, if applicable Date University of Hartford Office of Sponsored Programs (5) Director, OSP Date (6) Authorized Signature, Title Date 11. Delivery Who will submit this proposal (OSP or PI)? How? Electronic Express mail Hand delivery

Rev. 11/07/14 – OSP Template 005 ProSum Prepared by: Date Ext.: