The University of Georgia

/ GENERAL RESEARCH FUNDING FORM
(Route form and validated deposit ticket to Sponsored Programs)

Fund Information

THESE FUNDS ARE UNRESTRICTED IN REGARDS TO PUBLICATION AND OWNERSHIP
OF ANY INTELLECTUAL PROPERTY THAT MAY BE CREATED

Fund Type:

New

ROYALTY PAYMENT

Deposit to

FIELD TRIAL / FIELD STUDY (Agriculture)

Deposits are limited to $25,000 per deposit. All deposits will be budgeted as supplies.

GRANT (no deliverables are required to the sponsor)

Beginning Date

End Date

Sponsor / Payment Information

Amount:

Sponsor Name

Check Number:

Address

Check Date:

Date Check Received by Department:

City / State / Zip Code

DEPARTMENT INFORMATION

Department Fiscal Contact / Phone / E-mail Address
Principal Investigator / Banner ID / Phone / E-mail Address

Address: Department / Center / Mail Code

Department Org Code

PROJECT INFORMATION

Project Title:
Please briefly describe the general project area:

COMPLIANCE DATA

If any of the following categories are checked, additional clearances or approvals may be required prior to project initiation.
Animal Use IACUC# / Recombinant DNA/RNA / Radioactive Materials / Hazardous Waste
Human Subjects IRB# / Good Lab Practices / Hazardous Chemicals / Biohazards

REQUIRED SIGNATURES

By signing, the below certify that this request is in compliance with the VT Policy 3630: Definition and Deposit of Private Funds.

Authorized User / Investigator

DepartmentHead / Director

Dean / Vice President

Date: / Date: / Date:
GENERAL RESEARCH FUNDING DEPOSIT INSTRUCTIONS

The General Research Funding Deposit Approval Form is an internal Virginia Tech routing form that is used to certifygrant funds that support general research activities as opposed to specific research activities with identifiable deliverables. The classification of the funds must take into account the intent of the sponsor. This form should not be used to transmit funds received from governmental entities (federal, state, or local).

DEFINITIONS

Royalty Payment: Funds received as royalty payment to the inventor.

Field Trial / Field Study: Field Trial and Field Study accounts are used by the College of Agriculture only. The PI confirms that the sponsor desires to support the Land Grant mission of Virginia Tech by supporting field trials or field studies in the research area, and where Virginia Tech has an ongoing field trial/field study program in this area that is consistent with the research interests of the sponsor.

Grant: A general research grant may include a specific statement of work but nota required deliverable. All grants must be directed to the Office of Sponsored Programs. Any grant with a required deliverable should be routed as a sponsored project using the Proposal Approval Form and established as a restricted account.

Deliverable: A tangible product or service resulting directly from the use of funds transferred to the University for which the original sponsor will receive a material, tangible benefit for which they would not otherwise be entitled.

Type: New - original submission of this project. or Deposit - a request for additional funds.

Authorized User / Principal Investigator: The authorized user or PI, in case of a grant, is the person designated to be responsible for the administrative and programmatic aspects of the proposed project. There can be only one person designated as the authorized user / PI.

DONOR / SPONSOR

Sponsor: Please provide the name and address of the sponsor.

PROJECT INFORMATION

Project Title: Provide the title of the gift or project (limited to 120 spaces). Briefly describe the general research area.

COMPLIANCE

Use of Animal Subjects: Approval must be obtained from the Animal Care Committee prior to the initiation of any research if the project involves either living or dead vertebrate animals. Forms and information can be found at

Use of Human Subjects: If checked, a project plan and protocol must be submitted to the Institutional Review Board (IRB). The IRB must review and approve the proposal before research can commence. Forms and information can be found at

Biohazards, Hazardous Waste, and Hazardous Chemicals, and Radioactive Materialscompliance is coordinated by the Office of Environmental Health and Safety Services. Forms and information can be found at

Recombinant DNA/RNA: Please specify any recombinant DNA/RNA that will be used in this project. Answers to questions concerning DNA/RNA can be found at

Good Lab Practices is coordinated by the College of Veterinary Medicine.

REQUIRED SIGNATURES

Required Signatures: All fund holders plus their respective department head(s) / director(s) are required to sign the form. By signing, all parties certify that this request is in compliance with the University’s policy Definition and Deposit of Private Funds Policy 3630.

Revised 03/05/12