First Name *

Last Name *

Email *

Campus Address (Room Number & Building) *

Office Phone Number *

Organization/Company *

Address 1 *

Address 2

City *

State/Province *
- Select State Alabama Alaska American Samoa Arizona Arkansas Armed Forces Afr/Can/EU/ME Armed Forces Americas Armed Forces Pacific Baker Island California Colorado Connecticut Delaware Federated State of Micronesia Florida Georgia Guam Hawaii Howland Island Idaho Illinois Indiana Iowa Johnston Atoll Kansas Kentucky Kingman Reef Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Midway Islands Minnesota Mississippi Missouri Montana Navassa Island Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Palmyra Atoll Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Trust Territory of Pacific Utah Vermont Virgin Islands Virginia Wake Island Washington Washington D.C. West Virginia Wisconsin Wyoming

Zip/Postal *

First & Last Name of the Organization/Company Contact *

Email of the Organization/Company Contact *

Phone Number of the Organization/Company Contact *

Do you or any family member (defined as spouse, domestic partner, and/or dependent children) have any financial or equity interest in this organization? *
- Select Option Yes No

If YES, see the GVSU Faculty Conflict of Interest Guidelines.

Describe the Project *
Please enter at most 1000 characters. You currently have:

TIME FRAME FOR THE PROJECT

Project Begins *
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034

Project Ends *
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034

PROJECT BUDGET DETAILS
(Proposed Budget for Contract)

Personnel *
Faculty
GA(s)
Student(s)
None

Projected Cost of Faculty *

Projected Cost of GA(s) *

Projected Cost of Student(s) *

Equipment *
- Select Option Yes No

Projected Cost of Equipment *

Materials and Supplies *
- Select Option Yes No

Projected Cost of Materials & Supplies *

Travel *
- Select Option Yes No

Projected Cost of Travel *

Other Costs *
- Select Option Yes No

Describe the other costs and amount needed. *

Total Direct Funds *

Total Indirect Funds *

Total Budget for Project *

OTHER PROJECT INFORMATION

Do you anticipate intellectual property to result from this project? *
- Select Option Yes No Maybe

This project involves *
Human subjects or animals, or their blood/material/fluids
Pathogens/Biohazards
Hazardous/Regulated chemicals, radioisotopes
Recombinant DNA, stem cells or stem cell lines
Not applicable

Is the organization based in the USA? *
- Select Option Yes No I don't know

Does this project require an Export Control and Open Research Review Plan? *
- Select Option Yes No I don't know

Will the organization agree to use the GVSU Services Agreement? *
- Select Option Yes No I don't know