University of Wisconsin-Colleges

University of Wisconsin-Colleges

Grants, Gifts, and Contracts SupportTransmittal Form

1. Principal Investigator (Person with Primary Responsibility)
Name / Campus/Location
Email Address / Phone No.
2. Funding Source/Sponsor (Name, Address)
Program Description/Title
3. Description of Funding Source
Federal: CFDA Number: / State
Internal UW System Grant (ie OPID, Race/Ethnicity) / Foundation
Business / Local Source
4. Proposal Status
New / Renewal or continuation of current project
5. Budget
Proposed Budget Total: / $
Direct Services: / $ / Fringe Benefit rate applied to personnel / %
Indirect Costs: / $ / Indirect Cost Rate / %
Matching Funds: / $
6. Required Clearances: Check any that apply to the project. Provide a brief explanation of any item(s) checked.
Does the project involve toxic, infectious or carcinogenic/mutagenic material or proven hazard?
Does the project involve use of human subjects?
Does the project involve the use of vertebrate animals?
Does the project involve remodeling or construction?
Does the project have any environmental impacts which may require review under the Wisconsin Environmental Policy Act?
Provide a brief explanation of any item(s) checked:
Required Signatures:
Principle Investigator / Date
Campus Dean / Date
Project Review and Compliance: Send this extramural transmittal form, along with one complete copy of the grant proposal (by email attachment, PDF file, or mail) to: UW Colleges Grants Office; 708 Regent St., Madison, WI53708 (). The UW Colleges grants office will expedite a review process and will obtain required signatures on the transmittal form. The principle investigator maintains responsibility for submitting the grant proposal to the funding source.
UW Colleges Grants Office / Date
UW Colleges Academic Affairs / Date
UW Colleges Administrative Services / Date
UW Colleges Grants Accountant / Date
UW Colleges Codes (To be completed by campus or central business office)
Project Administered by: Unit / Division / Department / Program(s)
Award / New Project/Grant # / Add to project/grant
Non-Federal / 133-
Federal / 144-
Trust / 161/162
Other (specify type)
Amount Awarded: / $ / From / To
Amount Enclosed: / $ / Check Number(s)

University of Wisconsin Colleges

Revised May, 2005