Project Working Title: Click Here to Enter Text

Step I: Complete and turn in this page (Page 1) to the Office of Sponsored Programs prior to your proposal preparation and Step II. 1. General Proposal Information Project Working Title: Click here to enter text. Principal Investigator/Project Director: Click here to enter text. Phone: Click here to enter text. Fax: Click here to enter text. E-mail: Click here to enter text. Department/School/College/Institute: Click here to enter text. Other Lipscomb Faculty Involved: Click here to enter text. Sponsor/Agency: Click here to enter text. Grant Program Name (If applicable): Click here to enter text. Sponsor Deadline: Click here to enter text. Receipt Date or Postmarked Date (Note: To “check” any box in this application, double click on square checkbox and select “checked”) Total Project Period: Begin Date: Click here to enter text. End Date: Click here to enter text. Type of Project: Research Training/Instruction Public Service Event Other Type of Submission: New Continuation Revised Does this proposal involve the development of a new minor or major? Yes No Estimated Average Annual Funding Requested: $ Click here to enter text. F&A (Indirect Costs) Allowed? Yes No Cost/Sharing Match Required? Yes No

2. Briefly explain how this project fits into the mission of the University (please do not exceed space provided). Click here to enter text.

3. Provide a brief project summary that includes all colleges, programs and faculty involved with and/or impacted by the project (please do not exceed space provided). Click here to enter text.

Rev. 7/26/2012 STEP II: After Step I, complete this page (Page 2) and attach your proposal narrative and detailed budget, and submit these three things to your Department Chair, Director and/or Dean. 4. Summary Budget Requested Costs: Total for Entire Project Year 1 or Current Year Lipscomb University Cost Sharing/Match Direct Costs $ Click here to enter text. $ Click here to enter text. $ Click here to enter text. F&A Costs $ Click here to enter text. $ Click here to enter text. $ Click here to enter text. Total Request $ Click here to enter text. $ Click here to enter text. $ Click here to enter text.

5. Special Review Checklist Will your project involve human subjects? Yes No If yes, then notify the IRB (www.lipscomb.edu/irb) Additional Requirements/Considerations: If yes to any of the following, please explain: a) Is faculty release time requested? Yes No Click here to enter text. b) Is extra compensation to Lipscomb Yes No Click here to enter text. faculty or staff requested? c) Will this proposal require new full- Yes No Click here to enter text. time staff and/or faculty to be hired? d) Is more space required? Yes No Click here to enter text. e) Will students be hired from these Yes No Click here to enter text. grant funds? f) Is there a significant financial interest Yes No Click here to enter text. (as defined by University COI policy) of the investigators and/or family members that would reasonably appear to be affected by the project proposed? g) Any subcontract or consortia agreements? Yes No Click here to enter text. If yes, is Lipscomb the primary contractor or subcontractor? (circle or highlight one)

6. University Approvals (obtain in sequence) The Principal investigator or Project Director is responsible for securing his/her Department Chair’s and Dean’s signatures. After the Dean signs off on the routing form, please submit the entire proposal form and attachments to the Office of Sponsored Programs, which will interface with the Provost.

Investigator Certification: My signature below certifies that 1) I am not delinquent on any federal debt; 2) I am not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from current transactions by a federal department or agency; 3) I have not and will not lobby any federal agency on behalf of this award.

______Principal Investigator/Project Director Date

Administrative Approvals: The academic review of the proposal is the responsibility of the Department or School. These signatures indicate that the signers are familiar with the proposal and are responsible for all commitments in the proposal as they relate to their areas, space, personnel, or budget.

______Department Chair/Associate Dean Date

______Dean/Director/VP Date

______Grants Director Date

Rev. 7/26/2012 ______Provost Date

Rev. 7/26/2012