Request for action form

							Form - Request for Action                                   Office of Research Services (ORS)
                                                                      1737 West Polk Street (MC 672)
                                                                     304 Administrative Office Building
Version # 2.1                                                                       Chicago, IL 60612
                                                              Phone: 312.996.2862 Fax: 312.996.9005
                                                                                www.research.uic.edu




                              Request for Action
Date:

Name of Department:

Institution Number/PAF:

Name of PI:

Sponsor:

Amount:

Is this Request for Action related to American Recovery & Reinvestment Act (Federal
Stimulus Package)        YES       NO

Contact Person at UIC:

Phone #:

Email:

Delivered by:
                          Type of Action Requested
1. Grant
2.    Grant Acceptance
3.    Contract
4.    Contract/Grant Extension
5.    MTA
6.    Subcontract
7.    Amendment to add time and money to account #
8.    Supplement to account #
9.    No Cost Extension
10.   Reps & Certs
11.   Disclosure Form
12    W9 Form
13.   Other




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