Requested Account Title (30 Characters Only):
Purpose:
Estimated Duration: / Start Date: / End Date: / No end date anticipated
Project Director (must be a University employee):
College/Department or Administrative Unit Affiliation:
Revenue Source (fully describe):
Indirect Rate: / 7.5% of direct expenses / The indirect rate is 7.5% unless otherwise approved by the Director of Post Award & Contract Administration.

If revenue is from a nongovernmental organization, does the project director have a direct or indirect economic interest in it?

Yes No Not applicable

Are funds from non-campus entities anticipated? Yes No If yes, complete this section:

The University has a legitimate, substantive purpose for establishing this account at UEI because the activity:

(Check all that apply and explain checked items below. Use additional pages if necessary.)

is integral to the academic or service mission of the University or UEI

is a natural extension of an existing, academically related function

meets an important campus need

other

Explanation:

This project will involve: (Check all that apply and explain checked items below. Use additional pages if necessary.)

use of University space / sales of goods or services from educational activities
use of University equipment / international issues, including foreign nationals, exports, etc.
human or animal subjects / patents, copyrights, or proprietary information
underage children or disabled adults / University personnel paid to work on the account
volunteers / biohazards, hazardous waste, hazardous chemicals or radioactive materials
commercial sales of goods or services
Explanation:
The undersigned certifies, agrees and understands that:
1.  The requested account will not involve unrestricted donations to the University, sales of goods or services from educational activities provided by the University, commercial sales of goods or services owned by the University, or instructional programs carrying academic credit.
2.  Interest will not be paid for funds held on deposit.
3.  Facilities and administrative costs will be charged to the account at the percentage of total direct expenses indicated above.
4.  All University and UEI policies, procedures, and regulations will be followed when expending funds from this account, including but not limited to purchasing and hiring personnel and consultants.
5.  An authorized signer may not approve payments to him- or herself. Payments to the project director require the approval of the department chair, dean or, in the dean’s absence, the associate dean. If the project director does not report to a college dean, the appropriate associate vice president must approve the payment. / I approve this request to establish an account at University Enterprises, Inc. for the purpose described above.
Signature, Dean or AVP[1]: / Date
Name & Title (Print)
College or Administrative Unit
Director, Contract and Research Administration / Date
Signature / Date
Name & Title (Print)

Rev 07/2010

[1] If the project will not be associated with one of the colleges, an Associate Vice President must sign.