<p> THE UNIVERSITY OF MEMPHIS PROPOSAL SUMMARY FORM</p><p>PROJECT TITLE </p><p>PRINCIPAL INVESTIGATOR/PROJECT DIRECTOR DATA</p><p>Name ______Department/Center ______</p><p>Phone ______Fax ______E-mail ______Shared Credit ____ %</p><p>Co-PI/PD ______Shared Credit ____ % Co-PI/PD ______Shared Credit ____ %</p><p>Department/Center ______Department/Center ______AGENCY TRANSMITTAL DATA Requested Submission Date ______</p><p>Sponsor’s Name ______OR</p><p>ATTN: ______Required Deadline Date ______</p><p>Street Address ______Deadline Type Postmark</p><p>Bldg/Room ______Receipt by Sponsor City, State ZIP ______Number of Copies ______Sponsor’s Phone Number ______</p><p>BUDGET DATA Year One Total Period (for multi-year projects) AWARD TERMS</p><p>Requested Start Date ______Grant Contract (Cost-reimbursable) Requested End Date ______Contract (Fixed-fee) Requested Direct Costs $ ______$ ______Cooperative Agreement Other ______Requested Indirect Costs @______% $ ______$ ______</p><p>Total Requested Costs $ ______$ ______</p><p>PROPOSAL TYPE ACTIVITY TYPE COST-SHARING YES NO </p><p>New Research Amount Source (Acct Number)</p><p>Instruction/Training Preliminary $ ______- ______Public Service Renewal/Continuation * $ ______- ______Other Revision $ ______- ______</p><p>Subcontracts YES NO $ ______- ______Supplement * included? Current Account Number ___ - ______</p><p>SPECIAL REVIEWS Protocol Number Date Approved UNIVERSITY RESOURCES INVOLVED Yes No Use/Renovation of Space Not Currently Available to Project Human Subjects ______Yes No Use of Equipment Not Currently Available to Project Animal Use ______Yes No Use of Electron Microscopy Facilities Biohazards ______Yes No Use of Campus Telecommunication Resources Other (specify) ______Yes No Use of Personnel Not Currently Employed by U of M</p><p>NOTES</p><p>INDIRECT COSTS: Exception to the full federal indirect cost rate is requested for ACTIVITY LOCATION: for the following reason: On-Campus State of Tennessee agency @ 15 % Off-Campus* Sponsor allows a maximum of ______% indirect costs as verified by: Sponsor guidelines, page ______(or copy attached) and/or Office of Research Support Services *Off-Campus Definition: For all activities performed in facilities Other (please specify)______not owned by the institution and to which rent is directly allocated to the project. CERTIFICATIONS AND SIGNATURES</p><p>POLICIES AND PROCEDURES: By signature below, I certify that I understand that the expenditure of funds received for externally sponsored projects is subject to both sponsor guidelines and The University of Memphis Policies and Procedures. These polices and procedures are available on-line at the following web address: http://policies.memphis.edu/. Assistance in identifying applicable policies and procedures is available from Research Support Services.</p><p>CERTIFICATIONS AND ASSURANCES: By signature below, I certify that (a) I am not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from current transactions by a Federal department or agency; (b) I have not and will not lobby any Federal agency on behalf of this project; (c) neither I or my immediate family currently has a business relationship with the sponsor (other than through a sponsored project administered by The University of Memphis) or other possible conflict of interest with regard to this proposal.</p><p>FINANCIAL DISCLOSURE: Complete section (below right). See University of Memphis procedure “Disclosure of Financial Interests Related to Federally Sponsored Projects” (2A:18:01A ) at http://policies.memphis.edu/2a1801a.html for complete definition of financial interests.</p><p>ALL INVESTIGATORS/PROJECT DIRECTORS MUST SIGN FINANCIAL DISCLOSURE: Do you, your spouse, or dependent children have AND COMPLETE FINANCIAL DISCLOSURE SECTION: any financial interests related to the work to be conducted under the sponsored project? </p><p>______Principal Investigator/Project Director Date Yes No</p><p>______Yes No Co-Investigator/Project Director Date </p><p>______Yes No Co-Investigator/Project Director Date If yes, attach the name of each entity in which you have related financial interest and a description of financial interest for each entity.</p><p>DEPARTMENT/COLLEGE APPROVALS</p><p>The attached proposal has been reviewed and is consistent with Department and College plans and programs and requires no additional equipment, facilities, personnel time, or supporting services other than outlined in the proposal and/or indicated on this form.</p><p>FOR THE PRINCIPAL INVESTIGATOR/PROJECT DIRECTOR</p><p>______Department Chair Date Dean Date</p><p>FOR CO-INVESTIGATORS/DIRECTORS</p><p>______Department Chair Date Dean Date</p><p>______Department Chair Date Dean Date</p><p>OTHER APPROVALS (AS NEEDED)</p><p>______Signature Date Signature Date</p><p>FOR USE BY RESEARCH SUPPORT SERVICES </p><p>______Announcement Number CFDA # Received by Date</p><p>Underrecovery of Indirect Costs: ______Reviewed by Date</p><p>______RSS Proposal Log Number Date ______Approved by Date</p>