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 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Bellarmine University
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Office of Sponsored Projects
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Proposal Routing Form (PRO)
 |  |  |  | Letter of Intent (LOI) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PROP#:
 |  | Title of Project:
 | Principal Investigator Information |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Briefly describe how the purpose and objective enhance the following: |  |  |  |  |  |  |  |  | (Attach 1-2 paragraphs for each)
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | a.) Professional and departmental goals/priorities
 |  | Principal Investigator:  (Name) |  |  |  |  |  |  |  |  |  | Department: |  |  |  |  |  |  |  |  |  |  | b.) Institutional goals/priorities
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | c.) Describe how outcomes will be assessed
 |  | Co-Investigator:  (Name) |  |  |  |  |  |  | Department:
 |  |  | PI Phone |  |  |  |  |  |  |  |  |  |  | PI Cell Number |  |  |  |  |  |  |  |  |  |  |  |  | BU  E-mail Address
 |  | Departmental Secretary Contact |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Contact Phone |  |  |  |  |  |  |  |  |  | BU E-mail Address
 |  | Is this a Multi-PI Application? |  |  |  |  |  |  | Yes |  |  | No | If Yes, all PIs must sign below
 | Budget Information
 |  |  |  |  |  |  |  |  |  |  |  | Proposed Budget |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 69
 |  | Effective Dates of Project (MM/DD/YY) |  |  |  |  |  |  |  |  |  |  | FROM: |  |  |  |  |  |  |  | TO: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 30.3
 |  |  | Funds Requested |  |  |  |  |  |  |  |  |  |  | Direct Costs |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Attach full budget by year and |  |  |  |  |  |  |  |  |  |  |  |  |  | 23.7
 |  |  |  |  |  |  |  |  |  |  |  |  |  | Cost Share Costs |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | line item once determined.
 |  |  | On or [NAME] |  |  |  |  | Yes |  | No |  |  |  | Indirect Costs |  |  |  | % |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 62.5
 |  |  | F & A Rate |  |  |  |  | % |  |  |  |  |  | Total Costs |  |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 26
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 8
 | Project Information & Compliance
 |  | Special Reviews: |  |  |  |  |  |  |  |  | Project Approval**               (Date or "Pending") |  |  |  |  |  |  |  |  |  | Are there any [NAME]? |  |  |  |  |  |  |  |  | Yes |  | No |  | If Yes, How Many? |  |  |  |  |  |  |  |  |  | 1
 |  | IRB |  |  |  |  | Yes |  | No |  |  |  |  |  |  |  |  |  |  |  | Release time requested? |  |  |  |  |  |  |  |  | Yes |  | No |  | Explain: |  |  |  |  |  |  |  |  |  | 2
 |  | IACUC |  |  |  |  | Yes |  | No |  |  |  |  |  |  |  |  |  |  |  | Will students be hired? |  |  |  |  |  |  |  |  | Yes |  | No |  |  |  |  |  |  |  |  |  |  |  | 3
 |  | Biohazards |  |  |  |  | Yes |  | No |  |  |  |  |  |  |  |  |  |  |  | Will consultants be used? |  |  |  |  |  |  |  |  | Yes |  | No |  | If Yes, How Many? |  |  |  |  |  |  |  |  |  | 4
 |  | rDNA |  |  |  |  | Yes |  | No |  |  |  |  |  |  |  |  |  |  |  | Is more space required? |  |  |  |  |  |  |  |  | Yes |  | No |  |  |  |  |  |  |  |  |  |  |  | 5
 |  | Select Agents |  |  |  |  | Yes |  | No |  |  |  |  |  |  |  |  |  |  |  | Will there be space modifications? |  |  |  |  |  |  |  |  | Yes |  | No |  |  |  |  |  |  |  |  |  |  |  | 6
 |  | Radioisotopes |  |  |  |  | Yes |  | No |  |  |  |  |  |  |  |  |  |  |  | Cost Sharing/Matching? |  |  |  |  |  |  |  |  | Yes |  | No |  | If Yes, please list [NAME] (s) |  |  |  |  |  |  |  |  |  | 7+
 |  |  |  |  |  |  | Yes |  | No |  |  |  |  |  |  |  |  |  |  |  |  |  | Direct Cost Share |  |  |  |  |  |  |  |  | ($)
 |  | ** Applications with multiple projects or subcontractors must also obtain IRB approval for each subcontract or project that has human subjects |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Indirect Cost Share |  |  |  |  |  |  |  |  | ($)
 | Application Information
 |  | Funding Agency/Prime Sponsor |  |  |  |  |  |  |  |  |  |  | Agency Deadline |  |  |  |  |  |  |  |  |  |  | CFDA#/FOA/Solicitation Number
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | <Select> |  |  |  | <Select>
 |  | Application Type |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Prime Sponsor Type |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | New |  |  |  | Research
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Renewal (Competing Continuation) |  |  |  | Training
 |  | Activity Type |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Submission Method |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Non-Competing Renewal |  |  |  | Service/Educational Program
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Supplement |  |  |  | Other
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Transfer (indicate source below)
 |  | Is this a Subcontract? |  |  |  |  |  | Yes |  | No |  | If Yes, From Where? |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Resubmission
 |  | If this is an existing grant, please provide    _________________________ |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Revision (formerly Competing Supplement)
 |  |  |  |  |  |  |  |  |  |  |  | Agency # (if available) |  |  |  |  |  |  |  |  | BU Proposal Number |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]
 |  | Please check Yes or No, initial here signifying you have the read and understand the BU Faculty Council policy on Conflict of Interest located at http://www.bellarmine.edu/documents/FacultyCouncil/ConflictofInterest12103.doc: ___________ |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes |  | No
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | <Select> |  |  |  | <Select>
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Federal |  |  |  | [NAME]
 | Assurances |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | State |  |  |  | Grants.gov
 | PI/Sponsor Assurance:   I certify that:  (1) in conducting the proposed program, I am familiar with and will adhere to applicable Bellarmine University policies including, but not limited to, human and animal research, conflict of interest, misconduct in research, and and I accept absolute responsibility for the overall conduct of a sponsored project, including all technical, programmatic, financial compliance and administrative aspects, (2) the information submitted within the application is true, complete, and accurate to the best of the my (the PI's) knowledge; (3) any false, fictitious, or fraudulent statements or claims may subject me (as the PI) to criminal, civil, or administrative penalties; (4) I (as the PI) agree to accept responsibility for the technical direction and academic quality  of the project and to provide the required progress reports if a grant is awarded as a result of the application.  [NAME] of the School will have significant oversight responsibility; however that will not alleviate the PI's responsiblity level. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | City |  |  |  | [NAME] (NSF)
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Foundation (public or private) |  |  |  | Other Electronic
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Industry |  |  |  | Paper
 |  | PI Signature |  |  |  |  |  |  |  |  |  |  |  | Date |  |  |  |  |  |  |  | PI Signature |  |  |  |  |  |  |  |  |  |  |  |  |  | Date |  |  |  |  |  |  |  |  | University/Hospital
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Foreign Government
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Foreign Univ/Hosp
 |  | PI Signature |  |  |  |  |  |  |  |  |  |  |  | Date |  |  |  |  |  |  |  | PI Signature |  |  |  |  |  |  |  |  |  |  |  |  |  | Date |  |  |  |  |  |  |  |  | Foreign Industry
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Foreign Foundation
 | Departmental Assurance:  Faculty status, research/training program, space/facilities, personnel/efforts/salaries/wages, and budgets have been reviewed and approved. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other
 | Dept. Chair/Dean Approval |  |  |  |  |  |  |  |  |  |  |  |  | Date |  |  |  |  |  |  | Reviewed by BU OSP  Director |  |  |  |  |  |  |  |  |  |  |  |  |  | Date
 | Asst. Vice-Pres Academic Affairs |  |  |  |  |  |  |  |  |  |  |  |  | Date |  |  |  |  |  |  | Vice-President [NAME]. And Finance |  |  |  |  |  |  |  |  |  |  |  |  |  | Date