Proposal Sheet deArce-Koch Memorial Endowment Fund in Support of Medical Research and Development Proposal Deadline: Wednesday, January 16, 2019 PI Name: Title: Department: College: Mail Stop: Co-I Name: Title: Department: College: Mail Stop: Project Title: Your faculty appointment is 9-month 10-month 11-month 12-month Assurance of Compliance Does project involve human subjects? Yes No If Yes, IRB submission date approval date mm/dd/yyyy OR Does project involve animals? Yes No If Yes, IACUC submission date OR approval date mm/dd/yyyy Does project involve biohazards? Yes No If Yes, IBC submission date OR approval date mm/dd/yyyy Requested $ Fellowship (maximum six weeks salary + fringe benefits) $ Personnel $ Nonpersonnel Expenses $ Total (Not to exceed $25,000) Endorsements PI Date Signature mm/dd/yyyy Date Co-I Signature mm/dd/yyyy Dept. Chair Name Signature: Date: mm/dd/yyyy PI Dean Name Typed: Signature: Date: mm/dd/yyyy Dept. Chair Name Typed: Signature: Date: mm/dd/yyyy Co-I Dean Name Typed: Signature: Date: mm/dd/yyyy
Proposal Sheet deArce-Koch Memorial Endowment Fund in Support of Medical Research and Development Proposal Deadline: Wednesday, January 16, 2019 PI Name: Title: Department: College: Mail Stop: Co-I Name: Title: Department: College: Mail Stop: Project Title: Your faculty appointment is 9-month 10-month 11-month 12-month Assurance of Compliance Does project involve human subjects? Yes No If Yes, IRB submission date OR approval date mm/dd/yyyy Does project involve animals? Yes No If Yes, IACUC submission date OR approval date mm/dd/yyyy Does project involve biohazards? Yes No If Yes, IBC submission date OR approval date mm/dd/yyyy Requested $ Fellowship (maximum six weeks salary + fringe benefits) $ Personnel $ Nonpersonnel Expenses $ Total (Not to exceed $25,000) Endorsements PI Signature Date mm/dd/yyyy Co-I Signature Date mm/dd/yyyy PI Dept. Chair Name Signature: Date: mm/dd/yyyy Dean Name Typed: Signature: Date: mm/dd/yyyy Co-I Dept. Chair Name Typed: Signature: Date: mm/dd/yyyy Dean Name Typed: Signature: Date: mm/dd/yyyy
deArceCover.docx