NEW PI RESEARCH QUESTIONNAIRE

REVISED 10/17/2017

This form is for internal use only by OSP and should not be forwarded to the sponsor.

NAME

DEPARTMENT START DATE

1 Please Check

To which sponsors do you commonly submit proposals?

☐ Federal ☐ Commercial ☐ Other: ___________________________

Please check all Federal entities below that apply

☐ DOD ☐ DOE ☐ NASA ☐ NIH ☐ NSF ☐ USDA ☐ Other: _________ YES NO

2 ☐ ☐ Do you plan to transfer award(s) from a previous institution to Virginia Tech? If yes, how many? ______ Please provide name of transferring institution: _________________________

3 ☐ ☐ Do you conduct animal research? If yes, please identify animals used and if there are plans to bring any animal subjects with you to Virginia Tech: _____________________________________________________

4 ☐ ☐ Do you conduct human subject research? If yes, please provide an example of subject’s research involvement: ____________________________________________________________________________

5 ☐ ☐ Do you have plans to conduct clinical trial research? If yes, please explain: _____________________________________________________________________

6 ☐ ☐ Do you conduct export-controlled type research? If yes, please explain: _____________________________________________________________________

7 ☐ ☐ Does a spouse or dependent participate in your research (e.g., Co-PI, Key Personnel, etc.)? If yes, please explain: _____________________________________________________________________

8 ☐ ☐

Do you (or spouse or dependent children) have a significant financial interest (e.g., equity, ownership, consulting income, gifts or other payments) related to any planned sponsors, subcontractors, contractual services, etc.? If yes, please explain: _____________________________________________________________________ Also please review our Conflict of Interest Policy

9 ☐ ☐ Do you serve as a consultant? If yes, please explain consulting relationship(s): ________________________________________________

Which Federal agency systems do you currently have an established account with (e.g., NSF, eRA Commons, NSPIRES, etc.)? Please list all that apply: ___________________________________________

10 ☐ ☐ Have you updated your account affiliations to reflect Virginia Tech?

11 ☐ ☐ Are you familiar with Grants.gov proposal packages?

12 ☐ ☐ Will you accept funds if the sponsor requires that you obtain advance approval for public release/publication of the research results? Note: eliminates fundamental research exclusion and export controls may apply.

13 ☐ ☐ Do you plan to use any background Intellectual Property on research conducted at Virginia Tech? If yes, please explain: _____________________________________________________________________

14 ☐ ☐ Does your research involve any international partners/collaborators? If yes, please explain: _____________________________________________________________________

I CERTIFY THAT THE STATEMENTS ABOVE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.

PRINCIPAL INVESTIGATOR SIGNATURE DATE PRINCIPAL INVESTIGATOR NAME (PLEASE PRINT)

Please email the completed form to Laura Rasnick at Lrasnick@vt.edu