FORM GC1

Rev. 02/05/09

INTERNAL APPROVAL FORM

Grant & Contract Accounts (Fund 12)

Principal Investigator: / Email: / Employee ID:
Department: / College: / Campus Phone:
FAX:
Co-Investigator: / Email: / Employee ID:
Department: / College: / Campus Phone:
FAX:
Physical Location of Activity (Building):
Title of Project: / Contract Number:
Sponsoring Agency: / Phone: / FAX:
Address:
Contact Name: / Contact Email Address:
Current Budget Period From: / to / Total Project Period From: / to
Current Period Sponsor Budget: $ / Total Project Sponsor Budget: $
Check one box in each Section: / SPA USE ONLY:
Activity is:
Project is: / Postsecondary Education / Equipment Request / GRT#: ______
New / (Credit) / Financial Aid / CFDA: ______
Competing Renewal / Workforce Training/ / International Development
Noncompeting Renewal / Development / Multipurpose/Other / Funding Source
or Continuation of / Continuing Education / Specify / Fed % ______
Project Acct / Conference / State % ______
Supplemental / Other % ______
Activity type:
Instruction / Public Service
Institutional Support / Other sponsored activity
Does This Project Involve Any of the Following?
1. Human Subjects Yes No Date Approved: //
2. Animal Subjects Yes No Date Approved: //
3. Hazardous Materials Yes No
4. Radioactive Materials Yes No
Will this project require any of the following?
1. Purchase of Additional Equipment? Yes No
If yes, has KCTCS inventory been screened for availability of
existing equipment? Yes No
2. Additional KCTCS Space? Yes No If yes, attach explanation
Will any part of the project be conducted in non-KCTCS facilities? Yes No If yes, attach explanation
3. Alterations or Renovations of Existing Facilities? Yes No If yes, attach explanation
4. Faculty or Staff Overload? Yes No If yes, attach explanation
5. Subcontract or Outside Consultants? Yes No If yes, attach explanation
SPONSOR BUDGET:
Business
Unit / Department / Program / Class / Budgeted
Amount
0502 – Salaries & Benefits
0508 – Current Expenses
0506 – Utilities
0511 – Capital Outlay
51100 – Scholarships
0513 – Indirect Costs
TOTAL / 0.00
NON-SPONSOR COST SHARE BUDGET:
Business
Unit / Department / Program / Class / Budgeted
Amount
0502 – Salaries & Benefits
0508 – Current Expenses
0511 – Capital Outlay
TOTAL / 0.00

Remarks:

CERTIFICATIONS AND SIGNATURES

There must be signature approvals from all business officers, college presidents, chancellors or vice presidents whose personnel or facilities are involved in conducting the proposed work.

INVESTIGATORS' CERTIFICATION: My signature below indicates that 1) I am not presently debarred or suspended from receiving federal funds, 2) no federal funds were used for lobbying activities in connection with this proposal, 3) I am not delinquent on any federal debt, 4) the budget above represents the best estimate of the full costs of the project and identifies all sources of funds to cover full costs, and 5) in the conduct of the proposed project I will adhere to KCTCS policies including conflict of interest, ethical standards in the conduct of research, intellectual properties and the use of humans and animals in research.

BUSINESS AFFAIRS OFFICERS’/COLLEGE PRESIDENTS’ CERTIFICATION:

We certify that we have reviewed the proposal, including the full cost budget and sources of internal funds, and that it is consistent with the educational and research objectives of the unit. We also agree with the above distribution of indirect cost.

PRINCIPAL INVESTIGATOR (S) BUSINESS AFFAIRS OFFICER COLLEGE PRESIDENT CHANCELLOR(S)/VP(S)

PI
Date / Date / Date / Date
CO-PI
Date / Date / Date / Date