/ NAU Supplemental
Proposal Approval Form (PAF)

OGCS Proposal # Grant & Contract Administrator

For OGCS use only: Minorities Native Americans Environment Science Education

NOTE: The Supplemental PAF form is used to collect data that Cayuse 424 does not currently support, and will become redundant with late 2012 upgrades to Cayuse. Its purpose currently is to assure that all required information is documented and can be linked to the Cayuse 424 proposal and/or routing documents.

Please review the Certifications and Approvals on the 2nd page before approving this proposal for submission!

Principal Investigator (PI)

Academic Title / Name / Degree(s) / Employee Identity # (not SS#) / NAU User ID

Department/Unit and NAU Box # (Administering Department/ Unit, if different: )

Co-Principal Investigator(s) (Co-PI) Names and EIN(s)

Name / Department/Unit / NAU Box # / E-Mail Address / Telephone # / EIN / NAU User ID

Senior Investigator(s) and/or Key Personnel* (list additional individuals on a separate sheet)

Role / Name / Department/Unit / NAU Box # / E-Mail Address / Telephone #
Financial Conflict of Interest Disclosure
The above list is used to identify the PI and Co-PIs, and also to identify the names of all individuals, including Senior Investigators and/or Key Personnel, who must complete the NAU e-CERT (Conduct, Ethics, Reporting and Transparency) Programprior to proposal submission(E-Cert can be accessed through bblearn). Key Personnel are defined as those Individuals who contribute to the scientific development or execution of the project in a substantive, measurable way, whether or not salaries are requested.
Project AbstractProvide a description of the proposed project for inclusion in the Annual Report (limit 500 characters).
Project Outcomes (Publication, technical report, planning document, service provision, etc.)

Fiscal Information

F&A Rate (%) / On-Campus Off Campus / F&A Base MTDC TDC (other: select from drop down list)Internal approvals for redued F&A are attachedDocumentation of sponsor policy is attachedAZ Water Institute (AWI) (26% MTDC)BLM, BOR, USGS, US Fish and Wildlife (20% TDC)CPCESU (17.5% TDC)CPRS (15% TDC)USDA Forest Service RJVA (0%)US Department of Education (8%)Other:
Review the project with OGCS prior to preparing the budget to assure the F&A rate is consistent with the type and purpose of the project. Reduced F&A rates must be documented in the policy of the sponsor or in writing if approved by PI’s chair/director, dean, and the Vice President for Research, and submitted with the PAF.
Comment:

Cost Share Information

Is cost share (match) required by the sponsor? Yes No Cost share that is not required is voluntary committed cost share that must be tracked by the university and reported to the sponsor.

Indicate the type and source of required cost-sharing. For internal sources, approvals are given by electronic signature as part of the electronic routing of the proposal. Letters from third party contributors must be attached to the electronic routing package.

Nointernal cost shareis included Internal cost share is included and described below External (3rd Party) cost share is included

Description of the Cost Share:

Description of Cost Share (list the item and value ($) of all cost share including space, contributed (in-kind) salary, cash, etc.) / Account Number and contact name for each item
Internal Match
Department/Unit Commitments
College Commitments
University Commitments
Other internal match
External Match(list all 3rd party)

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Regulatory Compliance/Other Required Documentation (check all that apply to this project).

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Will the project require space, equipment or other support beyond those currently available? If so, attach a description of the requirements and the plan to meet these needs.

Involve new construction or renovation of current facilities? If so, attach a copy of the proposed changes and approval from Facility Services.

Include a Subcontract to another organization? If so, attach a completed copy of the Subrecipient Commitment form and the completed “Request to Issue a Subcontract” form.

Is this a NIH new or continuation proposal? If so, attach a completed copy of the NIH PI Certification form.

Does this proposal include general purpose (as opposed to project-related) operating, supplies, and materials not typically allowed under OMB Circular A-21? If so, attach a written justification.

Does the proposal include administrative salaries? Complete the Checklist for Direct Charging Administrative Salaries.

If this proposal builds on preliminary research supported by Prop 301 (TRIF) or the NAU IGP, please indicate the program and year of funding.

Are special permits, licenses, approvals or fees required? If yes, please explain below.

Are there international collaborations/activities involved in the project? If yes, please explain below.

Are any proprietary data and/or information contained in the proposal?

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Note: All forms are available on the OGCS website at

Certifications and Approvals

In signing the Proposal Approval Form, the Investigator(s) and/or Project Director(s) understand and attest:

(1)Responsibility for the scientific conduct of the project rests with the Principal Investigator (PI)

(2)Any false, fictitious, or fraudulent statement or claims may subject the PI to criminal, civil, or administrative penalties

(3)S/he is responsible for compliance with award terms and conditions and university policies and procedures; particularly for the technical conduct of the work, submission of technical reports, regulatory compliance, and financial management.

(4)Except as identified on this form and accompanying documents, the proposal does not obligate the University for funds for additional facilities, equipment, remodeling, extra operating funds, or matching funds, or for the establishment of new organizations, courses or programs not previously approved.

(5)The scope of work in the proposed project does not duplicate work funded by another sponsor.

(6)The amounts listed in the proposed budget for all listed direct cost items appear to be adequate for the performance of the proposed work

(7)S/he has read and understands NAU’s Conflict of Interest in Sponsored Projects (COISP) policy, has completed the E-Cert program, has made and/or updated all required disclosures prior to submission of THIS proposal, and will comply with any conditions or restrictions imposed to manage, reduce, or eliminate actual or potential conflicts of interest.

(5)S/he is aware of federal requirements on lobbying, and is in compliance or has disclosed any lobbying activity.

(6)S/he is not presently debarred or suspended from doing business with the Federal government.

(7)S/he is not delinquent on any federal debt, such as taxes, student loans, etc.

(8)If an award is made, s/he agrees to conduct the project in accordance with applicable laws, sponsor regulations, award terms and conditions, and University policy.

Signature ofChair(s)/Director(s) and Dean(s)indicates approval regarding the proposal’s purpose and methodology, faculty buyout and level of effort, and departmental/unit and/or college cost sharing that will be required for the project; are committed to providing the indicated resources, and approve submittal of the proposal.

PI, Chair(s)/Director(s), and Dean(s)affirm that unallowable costs under an award for this project will be transferred from the sponsored project account to a departmental account.

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Revisions made December 2011: Added a requirement for the PI to certify that the work is not duplicative of work funded by another sponsor; added a requirement that PIs, Chair(s)/Director(s), and Dean(s) affirm that unallowable costs will be transferred to a departmental account.

Revisions made May 2012: Removed redundant fields; added senior/key personnel list for Conflict of Interest Disclosure. Regulatory compliance disclosures (IRB, IACUC, IBC) are now provided in Cayuse 424.

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