Proposal Submission Notice

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Investigator Information: (Clarkson University Investigators only)

Contact E-mail:
PI Name:		Dept:		% of Project Effort:
Co-PI #1 Name:		Dept:		% of Project Effort:
Co-PI #2 Name:		Dept:		% of Project Effort:
Co-PI #3 Name:		Dept:		% of Project Effort:
Co-PI #4 Name:		Dept:		% of Project Effort:

Proposal Information:

Type of Request:	New Supplemental Continuation Renewal	Type of Project:	Research Student Support Equipment Fellowship Instruction Service Other
Received by	Postmarked by	Due Date:
Submitted to (Agency):
Project Dates:	Begin Date:
	End Date:
Proposal Title

Submission Information:

Electronic submission only	Mailing Address:
Paper submission
(Original plus copies)

Conflict of Interest:

Is there an actual or potential conflict of interest with the proposed work involving a Clarkson University employee, as defined by Clarkson University's Conflict of Interest policy at http://www.clarkson.edu/dor/coiform.pdf. (If yes, a Conflict of Interest Disclosure Form must be completed and submitted prior to proposal submission.

Yes No

Center(s) Allocation:

This project is also related to the following center(s) and the shown percentage should also be allocated to that center(s). (This is in no way affects the departmental credit for proposal submission to the Investigator(s) Dept.)	Center #1:		%
	Center #2:		%

Compliance Information

Check any of the following that apply to the proposed project. Explain how it pertains to your proposal.
Human/Animal Subjects (requires special committee approval)	Yes No
Use of hazardous or radioactive materials	Yes No
Export Control discussed in connection with proposal (describe).	Yes No
Involves collaboration with foreign entity (list entity)	Yes No
Involves proprietary information or materials (describe)	Yes No
Use of recombinant DNA (provide explanation)	Yes No
Use of Clarkson facilities to host a workshop or conference	Yes No
Waiver or reduction in Indirect Costs requested	Yes No
Matching Funds required (forward agency requirements)	Yes No

Additional Project Information

This project will involve a subaward to another institution.	Yes No Unsure
Name of Institution:	Institution Contact:
Name of Institution:	Institution Contact:
Name of Institution:	Institution Contact:
Name of Institution:	Institution Contact:
This project will involve cost sharing or matching funds from Clarkson University.	Yes No Unsure

Description of cost sharing:
Cost Sharing Approval (Dean of PI):
Cost Sharing Approval (Other):
Cost Sharing Approval (Other):

Budget Information

Detailed budget to be completed    See Below
This budget will include administrative/clerical salary and/or items currently classified as indirect costs (i.e. office supplies). Provide justification in the budget narrative.	Yes No

Budget Comments:
	Total Direct Costs:
	Total Indirect Costs:
	Indirect Cost Rate:	%
	IDC Base Amount:
	IDC Base Calc:
	IDC Base Calc:
Project Type
Project Type:	Basic Research Applied Research Prototype Development Clinical Trials
Research Topic 1:	None Selected Biotechnology Defense Applications Energy Environmental Protection Medical Health Nano-Technology Social Sciences Sustainability
Research Topic 2:	None Selected Biotechnology Defense Applications Energy Environmental Protection Medical Health Nano-Technology Social Sciences Sustainability
Research Topic 3:	None Selected Biotechnology Defense Applications Energy Environmental Protection Medical Health Nano-Technology Social Sciences Sustainability