Transmittal Form for internal grant applications
Office of Research and Graduate Studies (ORGS)
Competition: Choose an item.
Principal Investigator/Co-Investigator(s): ______
Departments/Units: ______
Principal Investigator/Co-Investigator(s): ______
Departments/Units: ______
Full Project Title (limit 80 characters, including spaces):
Short Project Title (limit 20 characters, including spaces):
Project Start and End Dates: to
Total Requested Amount: $
Project Abstract (250 word limit – use MS Word review and proofing tool to count words):
Project Needs and Special Considerations (Check “Y” for Yes, “N” for No, and “U” for Unsure)
Does your project involve the use of human subjects in research?...... Y N U
If “Yes,” have you received approval from the IRB? (Date approved: / / ) Y N U Does your project involve research using animals? Y N U
If “Yes,” have you received IACUC approval? (Date approved: / / ) Y N U
Does your project involve recombinant DNA?...... Y N U
If “Yes,” have you received IBC approval? (Date approved: / / )Y N U
Does your project involve biohazards, chemical hazards, radiation hazards, other safety concerns?....Y N U
Does your project involve blood-borne pathogens?...... Y N U
Does your project involve hiring additional personnel?...... Y N U
Does your project require space beyond departmental allocations?...... Y N U
Does your project require any space renovations, wiring, plumbing, etc.?...... Y N U
Does your project commit the University after completion of the project?...... Y N U
Does your project involve activities that may produce inventions, patents, or copyrights?...... Y N U
If “Yes” or “Unsure” to any Project Needs and Special Considerations, please explain:
Project Budget
Project Budget
/Request
Total Direct Costs / $0.00Principal Investigator (PI) and Co-PI Signatures (Note: The PI and all Co-PI’s must sign this form)
By signing below, you acknowledge that you have read the "Investigator Certifications" below and agree to be bound by them.
Investigator(s) Certifications
In compliance with CMU's Policies and Procedures regarding the conduct of externally funded activities, I certify the following:
1. I certify and attest that the information submitted within the accompanying application is original, true, complete and accurate. I am aware that any false, fictitious or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. I agree to accept responsibility for the scientific conduct of the project and to provide the required progress reports if a grant is awarded as a result of this application.
2. I certify that I have read, understand, and will comply with CMU’s Policy on Research Integrity, which can be found at and defines misconduct as “fabrication, falsification, plagiarism or other practices that seriously deviate from those that are commonly accepted within the scholarly community for proposing, conducting or reporting research and creative endeavors.”
3. I certify that I have read and understand my responsibilities toward this proposed project and, if funded, I will exercise the responsibilities outlined in the CMU Grant Manager’s Handbook, which can be found at
4. I certify that I have read and understand CMU’s Conflict of Interest Guidelines (COIG), which can be found at and that I will comply with the COIG and all conditions or restrictions imposed by CMU to manage conflicts of interest or I will forfeit the award. I further certify that I will continue to comply with the COIG throughout the life of this project and will update a Financial Disclosure Statement Regarding Sponsored Projects on an annual basis and whenever circumstances arise that would warrant a positive disclosure on a Financial Disclosure Statement Regarding Sponsored Projects.
5. I certify I have read and understand CMU’s Intellectual Property Rights Policy, which can be found at and further understand that I must promptly notify ORSP of subject inventions in sufficient time to permit the timely filing of patent applications prior to U.S. or foreign statutory bars.
6. I certify that I am in compliance with and will continue to comply with the provision of 41 USC Sections 51-58, the Anti-kickback Enforcement Act of 1986 (Pub. L. 99-734), in connection with the accompanying application.
7. I certify that I am neither presently debarred or suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in current transactions by any federal department or agency and I am not delinquent on any federal debt.
8. I understand, per OMB Circular A-21 ( that my time commitment to funded external and internal grants may limit my ability to earn supplemental income through CMU (e.g. overload, summer, or Global Campus teaching or other activities.
Principal Investigator (PI): Date:
Co-PI:Date: Co-PI:Date:
Authorizing Signatures (Note: All responsible chairs and deans must sign this form)
Chair:Date: Chair:Date:
Chair:Date: Chair:Date:
Dean:Date: Dean:Date:
Dean:Date: Dean:Date: