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					                                                                                                      RES FORM
                                                           Request for Extramural Support - Scripps Institution of Oceanography/UCSD
                                                                                                                                                                                UCSD #

Lead Department/ORU                                                                                              Fax #                                         Project Organization #
Lead Department/ORU Contact                                                                                      Phone #                                       Copying Index #
Email                                                                                                            Mail Code                                     Mailing Index #

                                                                              Principal Investigator:                                                           Co-Principal Investigator:
Last Name
First Name
Title
Department/ORU
Mail Code
Phone #
Email
     Will a PI Exception be Required?
          (Reference PPM 150-10)                                          Yes                        No                                                              Yes                         No

               Type of Award:                                                    Type of Proposal:                                                               Type of Project/Activity:

           Grant                                               New                           Revision                                          Basic Research                               Public Service
           Contract                                            Continuation                  Resubmission                                      Applied Research                             Other Service
           Cooperative Agreement                               Renewal                       Minority Supplement                               Developmental Research                       Equipment
           Subaward Contract                                   Supplement                                                                      Other Research                               Marine Facilities/Other
           Subaward Grant                                                                                                                      Training


Proposal Title:

                                     Proposal Information:                                                                                          Agency Information:
Award # (if applicable)                                                                              Agency Due Date (mm/dd/yy):
Duplicate Proposal #'s (if applicable)                                                               Agency Name
PA/RFA/RFP/etc # (if applicable)                                                                     Agency Contact                                                        E-mail
Project Begin Date (mm/dd/yy)                                                                        Phone #                                                         Fax #
Project End Date (mm/dd/yy)                                                                          Mailing Address:
Direct Costs                                                                                         Street
Indirect Costs                                                                                       City                                             State                           Zip Code
IDC Rate(s)                                                %                                         # of Copies Requested by the Agency:
                                                                                                     Will this proposal result in UCSD receiving a Subaward?                          Yes             No
Total Costs Requested:                                                                      $0       If Yes, list the "Prime" funding agency name

     Yes       No
A.                  Will on-campus space be used? If Yes, list building(s)                                                                 Room/Lab/Office #(s)
B.                  Will off-campus space be used? If Yes, list building(s)                                                                             Will rent be included in this proposal?               Yes      No
C.                  Will VA space be used? If Yes, list building(s)                                       Room#(s)                     Will more than 50% of the project be in VA space?                      Yes      No
D.                  Will animal subjects be used? If Yes, list date(s) approved                                               Protocol #(s)                          Species                                        Pending
E.                  Will human subjects be used? If Yes, list date(s) approved                                                Protocol #(s)                                                                         Pending
F                   Will human embryonic cells (any type) be used, or will other cell types or procedures be used that require ESCRO review? See Instructions.
                         If Yes, list date(s) approved by ESCRO                                                                   ESCRO protocol #(s)                                                               Pending
G.                  Will Conflict of Interest forms 9510 or 700-U be required? If Yes, include signed form(s).

H.                  Will UCSD equipment cost sharing be included? If Yes, include Equipment Matching form, or letter with approval signature(s).

I.                  Will UCSD expenditure cost sharing be included? For example; salaries, benefits, supplies, fellowships, and applicable indirect costs.
                         If Yes, list total $                            Fund #(s) of source                                        If other than departmental funds, attach detail with approval signature(s).
J.                  Will non-UCSD cost sharing be included? If Yes, list entity                                                                                                     List total    $
K.                  Will any genetically-modified agents be involved? For example; recombinant DNA.
L.                  Will any biohazardous materials be involved? For example; material of human/primate origin or infectious agents.
M.                  SIO Only - Will scuba or surface-supplied diving be used for data collection? If ship time is required, list ship name
N.                  SIO Only - Will Graduate Student Researchers be supported? If Yes, how many?
O.                  SIO Only - Will additional space be used? If Yes, include RES Addendum form.

P.                  SIO Only Has the PI certified completion of lab safety training for all employees, students, volunteers, and visiting scientists working in the PI's laboratory(ies)?

                                                                              Approval Signatures - Faxed signatures are acceptable

                                                     /                                                                                                           /
 Sign Name                      Principal Investigator                          Print/Type Name           Date           Sign Name                Co-Principal Investigator                      Print/Type Name      Date

                                                     /                                                                                                           /
 Sign Name                   Department Chair/Director                          Print/Type Name           Date           Sign Name                 Department MSO/DBO                            Print/Type Name      Date

                                                     /                                                                                                           /
 Sign Name          Participating Department Chair/Director                     Print/Type Name           Date           Sign Name          Participating Department MSO/DBO                     Print/Type Name      Date

                                                     /                                                                                                           /
 Sign Name                          Space Approval                              Print/Type Name           Date           Sign Name       VA Medical Center Research Administration               Print/Type Name      Date


                                                                                                  OCGA / SIO / HSSPPO USE ONLY

Sponsor Code                            Analyst Initials                  Reviewer                                         Date                            Federal Tracking ID (SIO use only)

Office of Contract and Grant Administration 7/2011
                                                     RES SPACE ADDENDUM
                                       Request for Extramural Support Space Addendum
                                                     University of California, San Diego


                                                                                           UCSD#




If this proposal is awarded, will any space be required for either people or equipment other than that specifically
listed in Items "a" and/or "b" on the RES?

        No

        Yes         If yes, explain:




If this proposal is awarded, do you foresee additional space requirements if the contract or grant is renewed?

        No

        Yes         If yes,                 When?

                                  Type of space?

                              Amount of space?

                                   For how long?




                    PI Signature                          Date                Department Chair Signature             Date

                 00                                              0                               0
               Print or Type PI Name and Title                                 Print or Type Department Chair Name




                  Co-PI Signature                         Date                Department Chair Signature             Date

                  00                                             0
              Print or Type Co-PI Name and Title                               Print or Type Department Chair Name




Office of Contract and Grant Administration 5/2004
                                                            UCSD PROPOSAL SIGNATURE PAGE
                                                                 The Regents of the University of California
                                                                    University of California, San Diego
                                                                                                                                      UCSD#

                                                  Principal Investigator:                                                     Co-Principal Investigator:
Last Name
First Name
Title
Department/ORU
Mail Code
Phone #
Fax #
Email
                                                                                         Agency Information:
Agency Name                                                                                           If applicable, include the following information:
Contact Name                                                                                          Award #
Contact Phone                                                                                         PA/RFA/RFP, etc #
Street Address                                                                                        Other required agency information, such as DUNS Number, etc.
City, State, Zip

Proposal Title


Project Begin Date                                              Project End Date                                    Total Costs Requested



Principal Investigator



                                 Principal Investigator Signature                                                                         Date



Co-Principal Investigator



                               Co-Principal Investigator Signature                                                                        Date



                                                     OCGA Official Authorized to Sign on Behalf of The Regents



                                             Signature                                                                                    Date




                                                                                Print or Type Name and Title




                                                         Please send award documents as indicated below:

             For General Campus and Health Sciences Proposals                                                  For Scripps Institution of Oceanography Proposals

            Mailing Address:                                   Courier Address:                                  Mailing Address:                         Courier Address:
        University of California-San Diego               University of California-San Diego            University of California-San Diego        University of California-San Diego
 Office of Contract and Grant Administration       Office of Contract and Grant Administration           SIO Contract and Grant Office             SIO Contract and Grant Office
         9500 Gilman Drive, Dept 0934                10300 N Torrey Pines Road, 2nd Floor               9500 Gilman Drive, Dept 0210              8622 Discovery Way, Room 116
        La Jolla, California 92093-0934                     La Jolla, California 92037                  La Jolla, California 92093-0210              La Jolla, California 92037
             Phone # 858-534-3330                             Phone # 858-534-3330                             Phone # 858-534-4570                   Phone # 858-534-4570
              Fax # 858-534-0280                               Fax # 858-534-0280                               Fax # 858-534-9642                        Fax # 858-534-9642




Office of Contract and Grant Administration 9/2006

				
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