The Neurological Emergencies Treatment Trials(NETT) Clinical Site Hubs Is an NIH Initiative

Should be on department letterhead

DATE: _____________

TO: Kevin Dillon

Executive Vice President, Chief Operating and Financial Officer

Office of Chief Business Affairs

Jodi Ogden

Associate Vice President, Sponsored Projects Administration

FROM: _____________________________

RE: REQUEST FOR WAIVER OF INDIRECT COSTS

ISSUE (reason for the waiver request): _____________________________

BACKGROUND: _____________________________

JUSTIFICATION FOR WAIVER (how the project applies to the University’s mission): _____________________________

DETAILED DESCRIPTION OF WAIVER COSTS: _____________________________

(ADD NAME) Principal Investigator DATE

Reviewed & approved by:

(ADD NAME) DMO DATE

Reviewed & approved by:

(ADD NAME) Chairman DATE

Approved by:

(ADD NAME) Dean DATE

APPROVED BY:

Jodi Ogden, Assistant Vice President, Sponsored Projects Administration DATE

Kevin Dillon, Executive Vice President, Chief Operating & Financial Officer DATE