Amherst College
EXPRESS GRANT & Contract Routing Sheet
Only use this form if the proposal:
1. is a non-federal application for fellowship, course development, or research funding; and
2. does not require any matching funds or contributions by Amherst College; and
3. does not involve animal or human subjects, recombinant DNA, purchases of equipment over $2,000, or a subcontract/sub-award with another institution.
All other proposals need to use the complete routing form.
Faculty/adminstrative staff member
Principal Investigator (PI) / First: / Last: / Department: / Project start date:Grant/agency information
Funding agency:
/Submission deadline:
/Grant Request: $
Grant information
Project Title:
Abstract (approximately 100 words):
Percent of academic year and/or summer to be spent on grant by PI: %
Location of project Amherst campus other:
Budget (check all that apply)
Grant will cover:
Summer salary for PI
/Leave replacement for PI
/Other personnel
Academic year salary for PI
/Visiting faculty
/Equipment
Travel
/Conference(s)
/Other (Explain):
OTHER GRANT CONSTRAINTS
If funded, will there be any restraints on publication of research results?
no yes (explain):Will the grant activities require the use of College IT personnel for training, set-up, maintenance or other function during or after the granting period?
no yes: I have discussed and received approval from the Director of ITSIGNATURES
Principal Investigator: ______
/Date: ______
Department Chair: ______
/Date: ______
Dean of the Faculty: ______
/Date: ______
Comptroller: ______
/Date: ______
Amherst College Express Grant Routing Sheet
this section to be completed by comptroller's officeSummary and Approvals
Direct costs
/ $ / Date:Indirect costs
/ $ / Date:Total $
/ $ / Date:Comptroller Information
Budget draft checked for: date, initials, comments
Mathematical accuracy
Salaries (rate increases)
Fringe benefits (rates)
Indirect cost (rate)
Assurances
Financial disclosure
Grants Invention Statement
Other
Final budget checked to draft
Amherst College Express Grant Routing Sheet: Disclosure of financial interst
Disclosure of Significant Financial Interest
Before completing please read The Financial Disclosure Policy. The following disclosure is made pursuant to the requirements of the PHS rule "objectivity in Research" (42 CFR Part 50 Subpart F) and NSF rule "The Investigator Financial Disclosure Policy." This disclosure must be updated annually, and whenever new reportable significant financial interests are acquired.
Definitions
Significant Financial Interest—Anything of monetary value, including but not limited to salary or other payments for services (e.g., consulting fees or honoraria), equity interests, and intellectual property rights. The term does not include (a)salary, royalties or other remuneration from Amherst, (b) income from seminars, lectures or teaching engagements sponsored by public or nonprofit entities, (c) income from service on advisory committees or review panels for public or nonprofit entities, (d) equity interest in business enterprises or entities if the value of such interests both does not exceed $10,000 and does not represent more than a 5% ownership interest for any one enterprise or entity when aggregated for the investigator and the investigator's spouse and dependent children, and (e) salary, royalties, or other payments that are not expected to exceed $10,000 over the next twelve month period when aggregated for the investigator and the investigator's spouse and dependent children.
Investigator—The Principal Investigator and any other person at the College who is responsible for the design, conduct or reporting of research educational or service activities funded, or proposed for funding, by certain Federal Agencies. Typically this will include the Principal Investigator and co-Investigators. For the purposes of this disclosure requirement, the term "investigator" includes the investigator's spouse and dependent children.
*Disclosure
Investigator Name: / Department / Renumeration:$
Source: /
Type of Organization:
pharmaceuticalfirm
biotech firm
/engineering firm
software firm
other
Nature of Remuneration that is greater than $10,000:salary royalties consulting licensing honoraria other
Types of holding whose fair market value is greater than $10,000:
stocks/stock options patents/copyrights other
Equity Interest of greater than 5%:Enterprise or Entity:
Signature
Investigator's Signature:
______/ Date:
______
*Please note a separate form is required for each enterprise or entity in which a significant financial interest is identified.