University of La Verne
Proposal Cover Sheet
(Please complete form in its entirety, obtain all signatures as noted, attach budget, proposal summary, support documents.)
1. Principal Investigator:
Last Name First Name Academic Discipline E-mail Address ULV Extension
2. Proposal Identification/Title:________________________________________________________________________________
3. Administering Department:______________________________________________________________________ __________
Program No. Object Code Contact Person E-mail Address ULV Extension
4. Granting Agency Name: ____________________________________________________________________________________
Agency Address: ___________________________________________________________________________________________
Application Due Date:________________ Project Begin Date:______________ Project End Date:______________
5. Proposal Type: □ Grant □ Contract □ Subcontract □ Coop Agreement □ Clinical Trial
Award will be: □ New □ Continuation □ Renewal □ Supplement □ Revision
Project is: □ Research □ Training □ Equipment □ Fellowship/Sabbatical Sponsorship
ULV research type: □ Applied □ Basic □ Development □ Other ________________________________
6. Proposed Budget Summary (See www.ulv.edu/grantassist/pdf/budget_plan_worksheet.xls for assistance in determining these
figures). Please attach copies of worksheets as Attachment 1:
Total Agency Total Project Matching
Budget Summary Direct Costs Indirect Costs In-Kind Cash
Request Amount Funds
Initial Project Year
Total Project Period (multi-
year projects)
Indirect Cost Rate:________% (explain how indirect is calculated)______________________________________________________
Direct Costs (on basis of personnel/explain)________________________________________________________________________
Source of Cash Matching Funds:_________________________________________________________________________________
In-kind details (provide Attachment 2) approval initials: Dean:______________ Provost/VPAA:_______________
7. Participants in Research: Humans will not be used in research Animals will not be used in research
Humans will be used in research IRB approval date:______________________
Animals will be used in research IACUC approval date:___________________
8. Conflict of Interest Statement: There is no potential conflict of interest.
There is a potential conflict of interest (plans for resolution, provide Attachment 3).
9. Departmental Approvals:
___________________________________________ _____________________________________________
Department Chair (if applicable) Date Principal Investigator Date
___________________________________________ _____________________________________________
College Development Director (if applicable) Date Dean Date
10. Administrative Approvals:
_____________________________________________________ _______________________________________________________
Associate Vice President for Finance Date Provost/Vice President for Academic Affairs Date
___________________________________________ _____________________________________________
Associate Vice President and Treasurer Date Manager of Grant and Foundation Support, University Relations Date