<p> University of Kansas Medical Center Research Institute PROPOSAL ROUTING SHEET FOR NON-COMPETING RENEWALS/CONTINUATIONS (Progress Report) </p><p>DEADLINE: Date/Time Received______SPA Proposal #_ </p><p>PROJECT PERIOD: FROM TO Continuation/Supplement to Acct # Principal Investigator (Last Name, First Name) Contact Name/Phone# E-Mail Address</p><p>PI's Department Administering Dept/Center (F&A Return Dept/Center)</p><p>Project Location (Room and Building) KUMC Centers Related Select: </p><p>Project Title: </p><p>Funding Agency/Institution Original Source of Funding (if KUMC is the subcontractor)</p><p>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</p><p>Key Personnel: Name Department Name Project Role EFFORT COMMITTED Cost Share Effort Original Effort Changed To (if appliccable)</p><p>Add additional page for key personnel not listed above</p><p>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 </p><p>______PI/Project Director’s Signature/ Date Dept. Admin. Initials Co-PI’s (if applicable) Signature / Date </p><p>(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. </p><p>______Department Chair/Center Director (typed/written) Department Chair’s/Center Director’s Signature</p><p>______Collaborating Dept. Chair (typed/written) Collaborating Dept. Chair’s Signature </p><p>KUMC Research Official Signature ______Director, Sponsored Programs Administration</p><p>SPA Rev. 10-17</p>