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					                                                           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

				
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posted:10/22/2011
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