Cayuse Questionnaire 2017

GENERAL INFORMATION

 

Project Title:     

Project Start Date:                                      Project End Date:     

 

Sponsor:     

Sponsor Program Name:      

Proposal Guideline URL:      

Sponsor Deadline:

 

Activity Code:

The Activity Code determines the standard indirect cost rate that is applied to your project. (Please review the embedded instructions at the end of this questionnaire if you are unsure which activity type applies.)         

 

Basic Research                                   Applied Research                                                Developmental Research

Training                                                  Public Service                                                        Other Service

Equipment                                                     Other

                      

INVESTIGATORS / PROJECT TEAM

 

Please list all senior or key UCSC personnel involved in this project as well as their role.

 

Name

Role

     

     

     

     

     

     

     

     

     

     

 

BUDGET

Please send a preliminary budget along with the completed questionnaire.

 

Does this proposal include funds or contributions in the form of cost sharing or cost matching?

Yes                          No

 

Do you need additional resources not included in the proposal budget to conduct this project?

 Yes   No

 

If yes, please specify the needed resources:      

 

REGULATORY COMPLIANCE

 

Are Human Subjects involved in the UCSC portion of this research?

Yes

No

If yes, please list the IRB #      

 

If no IRB # is available, please indicate the reason for not submitting an IRB application:

 Not required at proposal submission

 Submission is pending

 NA

 

 

Are Animal Subjects involved in the UCSC portion of this research?

Yes

No

If yes, please list the IACUC #:      

Also list the species involved:      

 

If no IAUCC # is available, please indicate your reason for not submitting an IACUC application:

 Not required at proposal submission

 Submission is pending

 NA

 

 

 

Does the proposal involve research with any of the following Research Materials?

Check All that apply

Radioactive Materials, Radiation Producing Equipment, Lasers

Biological Materials

Chemical Hazards

Materials provided by the sponsor or any other party

Controlled substances

Any of the 15 agents or toxins of Dual Use Research of Concern (DURC)

 

SUBCONTRACTORS

Does this proposal involve any subcontractors? Yes                      No

If Yes, list each subcontractor:

1.      

2.      

3.      

 

**If you are including payments to consultants, honoraria, or support to community collaborators, please check in with your Office of Sponsored Projects analyst to confirm if these should be considered a subcontractor.

 

EXPORT CONTROL

 

Yes

No

Have you signed or been asked to sign a Non-Disclosure Agreement (NDA) related to this project?

Do you anticipate that the project work may involve:

 

 

Sending, transporting, transmitting, or carrying any material or equipment related to this project outside the US (examples include: GPS, biological, diagnostic kits, reagents)

 

Travel outside the U.S.?

 

Transmitting funds, goods, technical data, or technology to any of the following countries on the OFAC list?

 

Some types of research may have export control implications even if all work is conducted within the U.S. Do you anticipate that the project work may involve:

 

 

 

Non-commerical encryption or information security software?

Any equipment, technology, materials, or software specifically designed, modified, or adapted (even slightly) for military or spacecraft end use, or for national security purposes?

Any classified materials, equipment, technology or data?

 

INTELLECTUAL PROPERTY

 

Yes

No

Have you disclosed any of this research to the Intellectual Property Office?

 

                     If Yes to question above –

                     What is the title and/or institutional identifier?  

                           

 

 

 

                     If No to question above –

                     Do you think this research has the potential for a patent?

 

Does the research in this proposal involve any filed patents?         

 

Does the research in this proposal involve any issued patents?

 

Will this research use any materials obtained from a third party under a transfer agreement granting ownership rights in inventions and/or data out of the use of the material?

 

Will this research use any material, patented or otherwise, which is owned by the institution and licensed to a commercial ent

 

Does your proposal contain proprietary or sensitive information?

Is this proposal a SBIR (Small Business Innovative Research Program) or STTR (Small Business Technology Transfer Program)?

 

 

LOCATION OF SPONSORED ACTIVITIES

Please list the locations where UCSC effort on the project will occur and assign a percentage to each location. The sum of all locations must equal 100%.

 

Location Type

Description of Location

Percentage %

On-Campus Locations

     

     

CA Off-Campus Locations

     

     

Out of State Locations

     

     

Out of Country Locations

     

     

 

PROPOSAL KEYWORDS

Please list 5-7 Kewords, separated by commas, which best describe the focus area of your project.      

 

PROPOSAL ABSTRACT

Please include a short 1-2 paragraph description of your proposed work. This can be a general summary. You can also send a draft of your research plan in lieu of this section.