Section 1100: Research, Sponsored Projects & Public Service
1130F Grant Proposal Clearance Form
Effective: July 1, 1999

Project Director (Principal Investigator) ____________________________________

Co-Director (Co-Principal Investigator) ____________________________________

Unit (Program/Office) Name(s) ___________________________________________

Title of Proposal ______________________________________________________

Brief Description:

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

Agency or Organization to receive proposal: ________________________________

Agency or Organization Program Name: ___________________________________

Type of application:
    New Continuation
    If continuation, RC #_____________ (Responsibility Center/Banner Index #)

Period of Support Requested: From _______________ to ______________

* The Director of Grants and Sponsored Research will assign a Proposal Preparation number when the proposal is first presented to the Director.

Reviews/Certifications/Assurances

Yes __ No __ Will the project require renovations or modifications to current university facilities or additional new space? (This includes expanded utility service to support additional equipment, e.g. computer, fume hoods, air conditioning, etc.) If yes, please attach detailed description to this form and obtain approval of the Provost.

Yes __ No__ Will the project involve human subjects, animals, controlled substances, radioactive substances, genetically altered materials or hazardous substances. If yes, please attach a detailed description to this form and obtain approval of the Director of Grants and Sponsored Research.

Yes __ No __ Do you as PD, any family member or any of the involved researchers or their family members have consulting agreements, management responsibilities or substantial equity (greater than $10,000 in value or greater than 5% total equity) in the sponsor, subcontractor or in the technology? If yes, please attach a detailed description to this form and obtain approval of the Provost.

Yes __ No __ Does this proposal involve participation of American Indian or other minority communities? If yes, attach a detailed description to this form and obtain appropriate approvals from these communities.

Proposed Budget

	Sponsor 1st Year Total	MSU-Northern Matching*** 1st Year Total	Grand Total
Salaries/wages Benefits(%____)* Subcontracts Contracted Services Supplies/Expendables Communications Travel Rent Repair & Maintenance Awards Equipment	______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________	______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________	___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________
Total Direct Costs	______________ ______________	______________ ______________	___________________
Indirect Costs**	______________ ______________	______________ ______________	___________________
Total Project Cost	______________ ______________	______________ ______________	___________________

You may substitute a budget page(s) for this page in a different format if it is more consistent with the requirements of the grantor.

Proposal Approvals

The project director (principal investigator) certifies that the statements on this clearance form are true and complete to the best of his/her knowledge, and accepts the obligation to comply with university policy and guidelines in conducting the project herein if a grant is awarded. The PD also certifies that he/she is not delinquent on any federal debt.

Required signature's are those of the Project Director (Principal Investigator) and the Chancellor or the Chancellor's designee. Other signatures signify that appropriate review of the proposal has been completed.

Overruns - unresolved cost overruns on G & C projects will be covered from the PI and Department's share of indirect cost collections. Primary responsibility for avoiding cost overruns belongs to the PI.

We have reviewed the proposal and concur that the project complies with the University mission, strategic initiatives, policies and guidelines.

_______________________________________________
Project Director / Date

_______________________________________________
College Chair/Dean / Date

_______________________________________________
Chief Fiscal Officer / Date

_______________________________________________
Director of Grants & Sponsored Research / Date

_______________________________________________
Associate Chancellor for Student Affairs / Date

_______________________________________________
Senior Vice-Chancellor/Provost / Date

 

Final Approval For Submission

The Final Approval for Submission section will be completed by the Director of Grants and Sponsored Research The MSU-Northern Business Office will assign a Banner Account number if the grant is awarded.

________________________________________________
Budget Review / Date

________________________________________________
Chancellor / Date

This form, in duplicate, is required for all proposals prior to submittal to outside sponsors by any member of Montana State University-Northern. It indicates to the administration and to the outside sponsor that all appropriate officials of the University have approved the proposal.

You are strongly urged to work with the Director of Grants and Sponsored Research early in the process. Such a procedure will save you a great deal of time.