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									SONOMA STATE UNIVERSITY                                                                                                                            ORSP #
Office of Research and Sponsored Programs, Stevenson 1024, 664-2448                          PRINTING INSTRUCTIONS            Rev. 11/2010

Proposal Endorsement Form
Directions: Use the "tab" key to advance through fields. Enter all pertinent information in shaded areas, drop-down menus, and check boxes. Obtain signatures #1-3 (page 4), and
return original proposal and endorsement form to the Office of Research and Sponsored Programs (ORSP). ORSP will obtain the remaining required signatures and notify you
when endorsement is complete.

This form must be filed with the ORSP at least 15 working days before the proposal deadline. Faculty applicants must present proposals for approval by the School
Dean and Department Chair at least 18 working days before the proposal deadline.
PLEASE CHECK      COST SHARE                         Yes FOREIGN                      Yes CONFLICT OF             Yes                              SSU SUB-                     ELECTRONIC        Yes
APPLICABLE BOXES: REQUIRED (#7)                      No TRAVEL(#9.F.)                 No INTEREST (#8)            No SSU PRIME                     RECIPIENT                    SUBMISSION        No

Principal Investigator                                                                       Co-PI                                                 Co-PI
PI Name:                                                                                     Co-PI Name:                                           Co-PI Name:
                        SELECT ONE
PI's employment status: 1                                                                    Employment status:         SELECT ONE
                                                                                                                        1                          Employment status:           SELECT ONE

School:                                                                                      School:                                               School:
Department                                                                                   Department                                            Department
Telephone                                                                                    Telephone                                             Telephone
Proposal and Sponsor
PROPOSAL TITLE:
Brief Project Description:




Sponsor Name (include division & title of program):
Contact Name / Title / Phone or email:                                                                                                             Telephone or email:
Sponsor Type: Federal                     Federal Pass                  State/Local               NonGovt.              If 'nongovernmental' see #8.B.
If Federal Pass, enter name of federal sponsor:
Is this a transfer from another University/Entity?       Yes        Enter Entity Name:

The proposal is best characterized as:                       Research

Timing
Sponsor Deadline Date:                                                                                 This is:         Postmark Date

Initial budget period (1 year or less):                                                                through
Total project period:                                                                                  through
The application is:            New                                                                                      Enter existing fund # for renewals:
If multiple-year project, indicate year of this request:
Budget
Indirect Costs Applied:        SELECT ONE                                                                               SELECT ONE                            Effective Rate:
Explanation for nonstandard IDC rate:

Budget Summary                Direct Requested               Indirect Requested              Total Requested            SSU Cost-Sharing*          Other Cost-Sharing*          Total Project Costs

      Year 1                   $                         -   $                           -   $                      -   $                      -   $                       -    $                      -
      Year 2                   $                         -   $                           -   $                      -   $                      -   $                       -    $                      -
      Year 3                   $                         -   $                           -   $                      -   $                      -   $                       -    $                      -
      Year 4                   $                         -   $                           -   $                      -   $                      -   $                       -    $                      -
      Year 5                   $                         -   $                           -   $                      -   $                      -   $                       -    $                      -
      Total                    $                         -   $                           -   $                      -   $                      -   $                       -    $                      -
*Match justification and sources (attach required documentation):
Personnel
                                                                 Employment Type /                Appointment           Additional description      Annual FTE%, WTUs,
           Name                      School / Unit                                                                                                                     Length of Appointment
                                                                       Rank                       Description                 / comment               months, days, or
                                                                                                                                                               FTE%

                                                                                                                                                               FTE%

                                                                                                                                                               FTE%

                                                                                                                                                               FTE%

                                                                                                                                                               FTE%

                                                                                                                                                               FTE%

                                                                                                                                                               FTE%

                                                                                                                                                               FTE%

                                                                                                                                                               FTE%

                                                                                                                                                               FTE%

                                                                                                                                                               FTE%




          9/19/2011                                                                   32c38594-68fa-4fb5-a4c8-234d87479c0c.xls                                                                Page 1
SONOMA STATE UNIVERSITY                                                                                                                 ORSP #
Project Requirements

INSTRUCTIONS: Answer the following questions by checking either the "Yes" or "No" box after each question. Provide any additional information requested.

1. HUMAN SUBJECTS

A. Does this project involve the use of human subjects (see http://www.sonoma.edu/uaffairs/policies/humansubjectspolicy.htm)?                   Yes                   No
If yes, the project must be reviewed and approved by the SSU Institutional Review Board (IRB).

B. If yes, what is the status of IRB review (check one)?         Approved (attach approval document),     Pending,             Application planned by (enter date):

2. ANIMAL CARE
A. Does this project require either the purchase, housing or handling of animals? If yes, attach an approval from the
                                                                                                                                                Yes                   No
Institutional Animal Care and Use Committee (IACUC) if required by SSU policy (see
http://www.sonoma.edu/uaffairs/policies/animalcare.htm)
B. If yes, what is the status of IACUC review (check one)?        Approved (attach approval document),        Pending,         Application planned by (enter date):

3. ENVIRONMENTAL HEALTH AND SAFETY

Does this project involve the use of environmentally or biologically hazardous materials (e.g. toxic or flammable chemicals,
recombinant DNA, pathogenic organisms, chemical carcinogens, radiation, etc.)? Does this project include the use of any                         Yes                   No
specialized equipment which may require any special safe guards or instruction (e.g. excessive noise, lasers, etc.)? If yes,
attach an approval document from the Environmental Health and Safety Department.

4. UNIVERSITY SPACE and/or FACILITIES

A. If funded, will the project require that additional space be assigned to the department? If yes, the proposal must be
                                                                                                                                                Yes                   No
coordinated with the appropriate Dean. Attach an itemized discussion of space requirements.

B. Will this project require the modification of existing facilities? If yes, attach a description of these requirements.                       Yes                   No
C. Is the use of existing laboratory space required? If yes,                                                                                    Yes                   No
          i. enter the lab room number(s) to be used.
          ii. describe the estimated amount of laboratory time and duration
          of use required.
D. Is the use of existing office space required? If yes,                                                                                        Yes                   No
          i. enter the office room number(s) to be used.

          ii. is the office space currently assigned to the PI, Co-PIs, or current project staff?                                               Yes                   No
E. Is the use of other (not lab or office) existing facilities required? If yes, attach a description of these requirements.                    Yes                   No
F. Will this project require Campus Space Committee approval?                                                                                   Yes                   No
5. EQUIPMENT AVAILABILITY/NEEDS

A. Are funds for equipment included in this proposal?                                                                                           Yes                   No

B. If yes, has equipment requested been checked with the existing department and university inventory?                                          Yes                   No

C. Are funds for maintenance of equipment included in this proposal?                                                                            Yes                   No

6. PROCUREMENT
A. Does this project require the purchase of any single piece of equipment valued at or greater than $5,000, including freight,                 Yes                   No
installation, sales tax, etc.? Or, a group of items that will be used to build a piece of equipment with total cost of $5,000 or
more?
B. Does this project require the purchase of any goods (non-equipment such as supplies, furnishings, etc) valued at or greater                  Yes                   No
than $50,000?

C. Will supplies of $5,000 or more be purchased, if yes, provide a detail list.                                                                 Yes                   No

D. Does this project require contracting for services with third parties valued at or greater than $50,000?                                     Yes                   No

E. Does this proposal include named subcontractors / sub awardees? If yes, attach a detailed budget and signed letter of                        Yes                   No
commitment from the sub recipient.

7. UNIVERSITY OBLIGATION

A. Are matching funds required by the sponsor? If yes, this must be explained in the proposed budget or on a separate budget                    Yes                   No
narrative.

B. Will University resources be committed as cost share? If yes, attach a signed Cost Share Authorization form.                                 Yes                   No

C. Will third party partner resources be committed as cost share? If yes, attach a signed letter of commitment from each                        Yes                   No
partner agreeing to provide cost sharing resources.

D. Has the University any obligation to continue this program beyond the life of the grant or contract? If yes, explain on a                    Yes                   No
separate sheet and coordinate with appropriate University officials.

E. Has the University any obligation to increase its participation during the life of the project? If yes, explain on a separate                Yes                   No
sheet and coordinate with appropriate University officials.




        9/19/2011                                                           32c38594-68fa-4fb5-a4c8-234d87479c0c.xls                                                       Page 2
SONOMA STATE UNIVERSITY                                                                                                                 ORSP #
8. CONFLICT OF INTEREST
A. Is this proposal being submitted to the National Science Foundation (NSF), NIH or an agency of the Public Health Service
                                                                                                                                               Yes                      No
(PHS)? If yes, complete the "Statement of Economic Interests for Principal Investigators on Proposals to Governmental
Sponsors."
B. Is this proposal being submitted to a non-governmental sponsor (e.g. private foundation or corporate sponsor)? If yes,
                                                                                                                                               Yes                      No
complete the "Form 700-U, STATEMENT OF ECONOMIC INTERESTS FOR PRINCIPAL INVESTIGATORS." See Reference
Guide for Exceptions.
9. OTHER APPROVALS

A. Is development of a new or expanded instructional program involved? If yes, coordinate with the Associate Vice Provost for                  Yes                      No
Academic Programs and attach approval document.
B. Does the project require A-95/E.O. 12372 State Clearinghouse review? If uncertain, contact the sponsoring agency or the
                                                                                                                                               Yes                      No
ORSP.
C. Does the project involve continuing education or summer sessions? If yes, coordinate with the Dean of Extended Education                    Yes                      No
and obtain approval signature.
D. Does the project involve more than one academic unit (i.e. School or Division)? If yes, coordinate with appropriate                         Yes                      No
departments and obtain approval signatures of department chairs and school deans / appropriate administrators.
E. Does this proposal require either the purchase or the maintenance of materials by the library? If yes, coordinate with the                  Yes                      No
Director of the Library and obtain approval signature.
F. Does the proposed project require international travel? If yes, complete and attach a Pre-Award Checklist for Proposals
                                                                                                                                               Yes                      No
Involving Foreign Travel, a Foreign Travel Risk Assessment Worksheet, and a Foreign Travel Liability Insurance Program
(FTLIP) ORSP Proposal Stage Request for Quotation.
G. Does this proposal manage protected 'Personal Confidential Information' (LEVEL 1 Data), such as SSN's, Birthdates, Credit                   Yes                      No
Card Numbers, etcetera? If yes, coordinate with the Information Security Officer for review and signature approval.
10. ELECTRONIC & INFORMATION
TECHNOLOGY (EIT) PRODUCTS & SERVICES
A. Will new or existing EIT equipment or software be required for this project?                                                                Yes                      No
If yes, answer questions 1 - 4 and the required certification (5) below:
Please check the box(es) for the types of EIT to be used for this project:
           New    Existing
   1.)                   Software Applications and Operating Systems
                         Web-based intranet and Internet Information and Applications
                         Telecommunications products, including telephone systems, voice response systems, and technologies involved with information transmission
                         Video and Multimedia products, including television displays and computer equipment with display circuitry that receives, decodes and displays
                         broadcasts, cable, videotape and DVD signals
                         Self-contained, closed products that have embedded software and include, but are not limited to information kiosks, information transaction machines,
                         copiers, printers, and fax machines
                         Desktop and portable computers
     2.) Who will purchase, set-up, configure, support and maintain the technology?


     3.) Who will support the technology at the end of the grant period, and how will this be funded?


     4.) How will the technology be disposed of, or refreshed, at the end of the grant period?


     5.) I have reviewed the University’s policy on Computer and Network Usage (http://www.sonoma.edu/uaffairs/policies/computer&network.htm) and I
     agree to abide by the requirements to register any computers purchased with IT.

         Agree (required)
B. Describe the requirements in each of the IT areas below, during and after the project life. Identify the personnel and funds required for installation, maintenance, support and
refresh. Please enter “NA” for technologies that will not be used for this project. If only existing School/Unit resources will be used, please state this explicitly. Please feel free to
contact the IT Grant Reviewer by email at, dustin.mollo@sonoma.edu or at x4-3340 for assistance with this section:
Hardware and
Workstations:

Network and Telephone:


Applications:


Servers:


Media Services


Computer Labs


Databases:


Web Services:


Other:




          9/19/2011                                                          32c38594-68fa-4fb5-a4c8-234d87479c0c.xls                                                               Page 3
SONOMA STATE UNIVERSITY                                                                                                         ORSP #
Signatures, Recommendations, and Required Approvals
Principal Investigator:
                                By signing this form I do hereby certify that the information submitted on this Proposal Endorsement Form and within the application is true,
Certification:
                                complete and accurate to the best of my knowledge.

Date:                                                                           Signature:

SCHOOL / DEPARTMENT RECOMMENDATION AND APPROVAL
Chair / Manager:                           Print Name:                                                   Recommendation:             Yes                    No

Comments:

Date:                                                                           Signature:

Dean/ App. Admin:                          Print Name:

Comments:

Date:                                                                           Signature:

RECOMMENDATIONS
Electronic & Info Technology:              Print Name: Jason Wenrick                                     Recommendation:             Yes                    No

               Comments:

                       Date:                                                    Signature:

Faculty Affairs:                           Print Name: Melinda Barnard                                   Recommendation:             Yes                    No

               Comments:

                       Date:                                                    Signature:

Human Services:                            Print Name: Terrie DeLorm, Designee                           Recommendation:             Yes                    No

               Comments:

                       Date:                                                    Signature:

Capital Planning:                          Print Name: Christopher Dinno                                 Recommendation:             Yes                    No

               Comments:

                       Date:                                                    Signature:

Procurement:                               Print Name: Ruth McDonnell / Joy Sun                          Recommendation:             Yes                    No

               Comments:

                       Date:                                                    Signature:               See EMAIL Approval

Environmental Health &                                                                                                               Yes
                                           Print Name: Craig Dawson                                      Recommendation:                                    No
Safety:
               Comments:

                       Date:                                                    Signature:

Police Services                            Print Name: Sally Miller                                      Recommendation:             Yes                    No
               Comments:

                       Date:                                                    Signature:               See EMAIL Approval

Other:                                     Print Name:                                                   Recommendation:             Yes                    No
               Comments:

                       Date:                                                    Signature:
        Reviewed by SPA:
                                                                                Signature:                                                        Date:
              Print Name:
INSTITUTIONAL APPROVAL
President or Designee                      Print Name: Saeid Rahimi, Interim Provost

               Comments:

                       Date:                                                    Signature:

CFO or Designee                            Print Name:

               Comments:

                       Date:                                                    Signature:




         9/19/2011                                                         32c38594-68fa-4fb5-a4c8-234d87479c0c.xls                                                   Page 4
SELECT ONE      SELECT ONE
Tenured         Adjunct
Tenure Track    Tenured
FERP            Tenure Track
MPP             FERP
                Lecturer
                MPP
                Other
Postmark Date
Sponsor Receipt Date
Target (No Deadline)



SELECT ONE
Federal On Campus = 51.0% SWB
Federal Off Campus = 24% SWB
SSU Non-Federal Minimum Rate = 15%
U.S. Dept. of Education = 8% TDC
UC Regents = 5% TDC
Other - enter rate:


SELECT ONE
NA
Flat $ Amount
% SWB
% TDC
% MTDC


New
Competing Renewal
Noncompeting Renwal or Continuation




Research
Instruction
Public Service
Fellowship
Equipment
Other - enter description:



Academic Affairs
AFD
ASC
Arts & Humanities
Business & Economics
Education
Extended Education
Library
Science & Technology
Social Sciences
SAEM
Other
Adjunct
Assistant Professor
Associate Professor
Graduate Assistant(s)
Lecturer
MPP
Post Doctoral
Professor
Staff, - exempt
Staff, - non-exempt




Additional
Assigned (Lecturer)
Bridge
Concurrent Job
Intermittent
Intersession
Release
Special Consultant
Staff - Administrative
Staff - Research
Summer
Teaching
Other


FTE%
WTUs
Month(s)
Day(s)
Hours

								
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