Page1of4
Revised2/4/2019
PaperColor|Blue‐WaterCenter|Gold‐University(Grant/ContractnotadministeredbyaCenter)|Green‐Manufacturing|Pink‐STEMCenter|Yellow‐Energy
PROPOSALENDORSEMENTFORM(PEF)
TennesseeTechnologicalUniversity|OfficeofResearch|DerryberryHall,Room128
ProposalNo.
__________________
ProposedProjec
tPeriod:(MM/DD/YY)
StartDate:_______________ |EndDate:
_
_______________
SubmissionType
NewProposal Supplement
Category:________________________
ProjectType:
_
___________________________
GrantPersonnel:Personnelcodes:001‐PI;002‐Co‐PI
Anyindividualwhohol
dsafull‐timeposition,suchastenured,tenuretrack,non‐tenuretrackresearch,directorofastate‐designatedCenterorUniversityCentermayserve
asaPrincipalInvestigator/ProjectDirectorforsponsoredactivities,andberesponsibleforacontractorgrant.Inaddition,anindividualwhoholdsthepositionofLecturer,
Instructor,Adjunct/Affiliate,Emeritus,orpart‐timefaculty(50%appointment)mayserveasaPrincipalInvestigator/ProjectDirectorforsponsoredactivitiesifheorshe
receivestheapprovalofhisorherchairanddeanasshownbytheirsignaturesonthisformandatenuredortenure‐trackresearchfacultyordirectorisnamedasco‐
investigatorontheproject.
SeniorPersonnel:Personnelcode:007‐SeniorPersonnel
OtherPersonnel:Personnelcodes:003‐SupportPersonnel;004‐Bookkeeper;005‐SubrecipientMonitor; 006-Budget Preparer
Thetablebelowshouldincludeallbudget‐relateditemsassubmittedtothefundingagency(i.e.,allrequestedfundsandrequiredcostshare).
Agency DepartmentalCost
Share
CenterCostShare TTUCostShare Otherand/or
In‐KindCostShare
1. TotalDirectCosts
2. ModifiedTotalDirectCosts
3. IndirectCostRateUsed
(Attach
supporting
documentation
ifdifferentfromTTUrate)
%
% %
%
%
4. TotalIndirectCosts Recovered Contributed Contributed Contributed Contributed
5. IndirectCostWaived
6. TotalProjectFunds
Costshare:Mandatory⃝orVoluntary⃝Ifcostshareismandatory,providedocumentation(e.g.,solicitation,emailfromprogramofficer,etc.).
ProposalTitle:
FundingAgency:
AgencyAddress:
ProgramOfficerInfo:
Name T‐Number Personnel
Code
College Dept. Center
Name T‐Number Personnel
Code
College Dept. Center
007
007
007
Name T‐Number Personnel
Code
College Dept. Center
Page 2 of 4
Proposal No.
__________________
Source of Center Cost Share
Source of TTU Cost Share
Source of Other and/or In-Kind Cost Share
Information Needed for Internal Tracking
In cases where waived or contributed indirect costs are not included in the table on page 1 because they were not allowed to be counted
toward the required cost share or no cost share is required, enter the amount of waived and contributed costs below:
Waived indirect costs
Contributed indirect costs
Yes
No
MUST BE COMPLETED BY PI AND NOT A PROXY.
Is extra pay requested? If yes, agency approval is required in writing.
Does this proposal/project involve any restricted data, inventions, or proprietary information? If yes, contact the Office of
Research.
Are subawards/consultants included in proposal? If so, list Subcontract Monitor in Grant Personnel.
Will this project involve restrictions on dissemination of results? If yes, contact the Office of Research.
Will this project include any export control restrictions? If yes, contact the Office of Research.
Does this project involve human subjects? If yes, date application is submitted to TTU Institutional Review Board (IRB) for the
Protection of Human Subjects:___________
Does this project involve animal care and use? If yes, date application is submitted to TTU Institutional Animal Care and Use
Committee (IACUC): ____________
Does this project involve recombinant DNA molecules/infectious or biohazardous agents/radiological hazards?
If yes, contact Safety and Environmental Services at (931) 372-3524.
Are computer purchases required? If yes, contact Information Technology Services at (931) 372-3387.
Is equipment to be purchased? If yes, contact Purchasing at (931) 372-3491.
Is space available for computer/equipment purchases? If no, contact Facilities at (931) 372-3227. Are additional project funds
requested to meet space, electrical, and/or maintenance needs? _____ No _____ Yes
Have you been debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered
transactions by any federal department or agency? If yes, contact the Office of Research.
Have you, within a three-year period preceding this proposal, been convicted of or had a civil judgment rendered against you
for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public
(federal, state or local) transaction or contract under a public transaction; violated federal or state antitrust statutes or
committed embezzlement, theft, forgery, bribery, falsified or destroyed records, made false statements, or received stolen
property? If yes, contact the Office of Research.
Are you presently being indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state or local)
with commission of any of the offenses numerated in the question above? If yes, contact the Office of Research.
Have you, within a three-year period preceding this application/proposal, had one or more public transactions (federal, state
or local) terminated for cause or default? If yes, contact the Office of Research.
(Note: By marking “No” in this section, you certify that no lobbying has been done prior to the proposal being approved and
that no lobbying will be done after it has been approved. If yes, contact the Office of Research.) To the best of your
knowledge, have any lobbying activities been conducted relative to this proposal?
Source of Department Cost Share
Page 3 of 4
Yes
No
Are you or any member of your immediate family (spouse, parents, parents-in-law, siblings, children, other relatives living at
the same address as you, or reported as dependents on federal income tax forms) an officer, director, partner, trustee,
employee, advisory board member, or agent of the external organization funding this project or of any organization from
which goods and services will be obtained under this project?
Do you or any immediate family member have any significant financial interest including, but not limited to, salary or other
payments for services (greater than $10,000 per year from sources other than the employee’s institution), equity interest
(greater than $10,000 in value or more than 5% of the ownership interest in a single entity), and intellectual property rights in
the external organization funding this project or of any organization from which goods and services will be obtained under this
project?
Do you have any affiliation with the external organization that would diminish your ability to fulfill your paramount obligations
to your students, your colleagues, or the University; or have you involved any student in a proprietary capacity with the
external organization?
I certify that I DO DO NOT have any significant financial interests associated with the aforementioned proposal/project.
Comments: (e.g., Center Research Area) _________________________________________________________________________________
_________________
_________________________________________________________________________________________________
Certifications: By completing, signing and submitting this form, (1) the principal investigator(s)/coPI(s)/project director(s)
provide(s)
the certifications shown on the attached Certifications, Disclosures and Assurances Form and (2) the Center Director(s) certifies
that
the project addresses one or more goals of the Center.
The Principal Investigator(s)/co-PI(s)/Project Director(s) also certify that they are qualified to perform the work outlined in this
proposal.
I hereby certify that:
The information submitted within the application is true, complete, and accurate to the best of my knowledge.
I understand that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative
penalties.
I will accept responsibility for the scientific conduct of the project within a drug-free, non-discriminatory workplace.
I will provide, in a timely manner, the required reports to the sponsor if a grant is awarded as a result of the application.
Page 4 of 4
Proposal No.
__________________
APPROVALS
(In Sequence) MUST be signed by PI and Co-PIs, and appropriate administrators [Director(s), if applicable, Chairperson(s), and
Dean(s), and, if applicable, Research Liaison Off
icer] PRIOR to submission to Office of Research.
Principal Investigator Date
Co-PI/Senior Personnel/Support Personnel Date
Co-PI/Senior Personnel/Support Personnel Date
Co-PI/Senior Personnel/Support Personnel Date
Co-PI/Senior Personnel/Support Personnel Date
Co-PI/Senior Personnel/Support Personnel Date
Co-PI/Senior Personnel/Support Personnel Date
Co-PI/Senior Personnel/Support Personnel Date
Co-PI/Senior Personnel/Support Personnel Date
Co-PI/Senior Personnel/Support Personnel Date
ADMINISTRATIVE SIGNATURES REQUIRED
Note: If this project is funded, by signing this form, you are certifying that faculty members’ total commitment will not exceed
1 FTE combined with other duties.
Center Director(s) Date
Dean or Liaison Officer (of PIs/Co-PIs/Senior Personnel) Date
Center Director(s) Date
Dean or Liaison Officer (of PIs/Co-PIs/Senior Personnel) Date
Departmental Chairperson(s) (of PIs/Co-PIs/Senior Personnel) Date
Dean or Liaison Officer (of PIs/Co-PIs/Senior Personnel) Date
Departmental Chairperson(s) (of PIs/Co-PIs/Senior Personnel) Date
Office of Research Date