Proposal Check-Off Sheet
(Sample only, not downloadable)

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Proposal No. ____________

Title of Proposal: __________________________________________________________________

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SIGNATURES:                                 DATE:                  BY SIGNING BELOW, THIS INDIVIDUAL
                                                                                  CERTIFIES THAT:

___________________________      __________          The work can be performed as stated
Principal Investigator                                                         in the technical section of the proposal
                                                                                  with the resources, facilities and funds as
                                                                                  mentioned, and the PI has completed the
                                                                                  reverse side of this form. I affirm that no graduate
                                                                                  student thesis or completion of a degree will be
                                                                                  promised to any sponsor as a deliverable for this project.                                                                     

___________________________      __________          The work proposed is technically sound
Department Head                                                             and can be performed with space, utilities
                                                                                  and resources currently available on
                                                                                  campus. (If anything is missing that is
                                                                                  needed to make the above mentioned
                                                                                  research work, please state below what is
                                                                                  required. Give adequate detail).

___________________________       __________          The proposed research fits within the
Center Director                                                                 mission of this center. Any overhead
                                                                                  recovery resulting from the project will be
                                                                                  used to further that mission.

_____________________________    __________          The proposal has been reviewed for
Representative of Research Administration                                 format, budget, and meeting any special
                                                                                  requirements as stated in an RFP or
                                                                                  program guidelines. The terms and
                                                                                  conditions as proposed, and the budget,
                                                                                  fulfills all financial requirements for audit
                                                                                  purposes. Also, a determination has been
                                                                                  made as to whether the Colorado School
                                                                                  of Mines has engaged in any lobbying
                                                                                  activity at the federal level in support of
                                                                                  this request. Appropriate disclosures
                                                                                  have been completed.

___________________________       __________          The proposed research is accepted by
Director of Research Administration                                         the Colorado School of Mines as work
                                                                                  that can be performed within the
                                                                                  university. If cost sharing is shown on the
                                                                                  budget, it has been reviewed by this office
                                                                                  and is acceptable as stated.

COMMENTS:
In the absence of the Director of ORA, the following individuals are authorized to sign proposals: V.P. for Research & Technology Transfer, V.P. for Academic Affairs, & Assoc. V.P. for Academic Affairs.

 

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The following questions should be addressed by the Principal Investigator before obtaining the signatures required above on this form. The purpose is to identify unusual conditions, circumstances, costs or vulnerabilities associated with the proposed work before requests for funding are submitted to external agencies.

• Health and Safety



Review and respond as necessary to attached "Research Proposal Health and Safety Checklist."

 

• Competition with the Private Sector



1. Does the project involve students or post-doctoral associates?          Yes ___ No ___



2. Do you believe that it is unlikely that any Colorado-based company or corporation can completely fulfill the statements of proposed work for profit?              Yes ___ No ___





If the answers to both questions are "no," please attach a brief statement to explain why this project would not be in competition with the private sector.

 

• Extraordinary Facilities or Space Requirements




1. Are any of the equipment, space and utilities required for this proposed project currently not available on campus?                                                                           Yes ___No ___





2. Does the proposed project involve new construction or alterations of existing CSM buildings?                                                                                             Yes ___No ___





3. Do you plan to use human or animal subjects in your research?  Yes___ No___

 

    4.  Does your research involve select agents?  For information about (and a list of) "select agents" go to

         CDC website http://www.cdc.gov/od/sap/                                    Yes___ No___



If the answer to any of the above is "yes," please attach an explanation. This should include the results of preliminary discussions with Buildings and Grounds officials at CSM.

 

• Intellectual Property Rights



1. Does the proposal include the assignment of intellectual property rights to any party other than CSM or the Principal Investigator?                                          Yes ___ No ___



2. Does the proposed project have industrial confidentiality or involve controls of the National Security Act?                                                                             Yes ___ No ___



3. Does the proposal contain any agreement to delay or screen publication of the results of the research?                                                                      Yes ___ No ___




If the answer to any of the above is "yes," please attach an explanation.

 

• Export Control

1. Does the proposed research involve any Export Administration Regulations (EAR)?  See      Parts 734, 738, Supp. No. 1 to 738, 772, and 774 (URL:  Export Admin Regs).    Yes______  No _____

2. Does the research involve any item on the ITAR (International Trade in Arms Regulations) Munitions List? See 22 Code of Federal Regulations Parts 120, 121, and 126 (URL:  US State Department).                 Yes ______ No _____

3. Does the research involve technology or devices designed for use in military, security, and intelligence applications?  Yes ____   No _____

4. Does the research involve anything else with a substantial or dual-use military application?  Yes _____ No _____

5. Will you collaborate in any way with a foreign national?    Yes _____ No _____

6. Will you use a research assistant that is a foreign national?    Yes _____ No _____

7. Will you send your research results to a foreign country or foreign citizen?                       Yes _____ No _____

8. Do you anticipate any foreign travel associated with the project?   Yes _____ No _____         If yes, state where to and for what purpose below.

    If the answer to any of the above is yes, please attach an explanation.

________________________________
Principal Investigator

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Send comments & questions to Sharon Dehmlow
Return to Proposals or Research Proposal Preparation Process
Last Modified: October 02, 2007