PRESIDENT’S RESEARCH FUND (PRF)

ApplicationForm:SubawardIntenttoEstablishaConsortium

* The Administrative PI of the PRF application prepares this Form in collaboration with each Subrecipient

* The Form must be signed by an *Authorized Signatory Official of the Subrecipient.

SaintLouisUniversity(SLU)PrincipalInvestigator(PI,withadministrativeresponsibility)

FirstName / LastName / Division / School/College/Center / SLUEmail
[First] / [Last] / [Division] / [School/College/Center] / [identity]@slu.edu

SLUProposalTitle

[PRFApplicationTitle]

SubrecipientBusinessNameandAddress

[Subrecipient/ConsultantBusinessName],[BusinessAddress]

SubrecipientScopeofWork Describespecifictasksto becompletedanddeliverablestobeperformedestimatingspecific

deliverydatesasapplicable.For ConsultantsONLY, describe professionalexpertiseinadditiontodescribingtheworktobe performed. If additionalspaceisneeded,pleaseattachan additional page. However,pleasenotethatonlythefirstpagewillbesharedwithPRF Peer Reviewers. A SLU Scope ofWork templateisalsoavailablefor reference.

SubrecipientBudget Allbudgeteditemsbelow must beitemized. For ConsultantsONLY, anhourly ordailyratemaybe proposed. If additionalspaceisneeded,pleaseattachan additional page. However,pleasenotethatonlythefirstpagewillbesharedwithPRF Peer Reviewers.

Description / Amount / NarrativeJustification
Wages / 0 / [itemizednarrativejustification]
FringeBenefits / 0 / [itemizednarrativejustification]
[Other] / 0 / [itemizednarrativejustification]
TOTAL / 0

IntenttoEstablishConsortium

I.[SUBRECIPIENT]intendstocollaboratewithSaintLouisUniversity(SLU)onthe ScopeofWorkabove.

II. Aperiodofperformance beginningMarch1,2016andendingFebruary28,2017isanticipatedtobefundedbySLU

asdetailedinthebudgetabove.

III. IfthisProposalisawardedfunding,[SUBRECIPIENT]willprovideanycurrentnoticesofapprovalforanyandall animaland/orhumansubjectsprotocolswhichmayapplytothisproposal,anddocumentationofhumansubjects educationcertificationforindividualsworkingontherelatedhumansubjectsprotocols.Awardedfundswillnotbe releaseduntilthedocumentationis provided.

IV.[SUBRECIPIENT] willassurefullcompliancewithawardtermsandconditions,aswellastheregulatoryand administrativerequirementsofSLUandanygovernmententitywithauthorityand jurisdictioninsaidmatters.

V. Theappropriateprogrammaticandadministrativepersonnelof[SUBRECIPIENT]areawareofSLU’sconsortium grantandcontractpoliciesandarepreparedto establishthe necessaryagreementconsistentwiththatpolicy.

[SUBRECIPIENTBUSINESS NAME]

Authorized*Signature:[AuthorizedSignatureofSubrecipient]DateReceivedfor Review:10/15/2015

SignatureDate:10/15/2015

[Full Name], [Title],AuthorizedSignatoryOfficialof theSubrecipient

[Email Address], [PhoneNumber]

Complete,signedformsaredueontheapplicationdeadline.

Late, incomplete, orunsignedFormswillNOTbeacceptedforreview.

*ForquestionsregardingthisForm,pleasecontacttheOfficeofResearchServicesator(314)977-7742.We

stronglyrecommend contacting uswith anyquestionswellin advance of the January 15submission deadline.

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