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SBIR-STTR Routing form revise March 2013docx

By Marilyn Hamilton,2014-04-16 05:19
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SBIR-STTR Routing form revise March 2013docxMarch,MARCH,Form,docx,form,FORM

     SBIR/STTR Form

    SBIR Grant: STTR Grant:

    This form must be completed under the following conditions:

    1 When a CWRU faculty or staff member will be the PI of the subcontract to CWRU and the

    application requires intent to enter into a subcontract documentation signed by an

    Authorized Organizational Representative. SOM signatory: Robin Bissell All other schools:

    Diane Domanovics. The completed form is to be uploaded to the eURF and then sent to som-

    resadmin@case.edu (SOM Only). Note: The PI for the CWRU subcontract may not be the same

    as the PI for the SBC.

    2 When the PI of the SBIR application is employed by CWRU and the application therefore

    requires a letter confirming that the PI will become a less than half time employee of CWRU

    and will remain so for the duration of the project if the project is funded. The completed

    form and a draft letter detailing the CWRU faculty/staff members status if the SBIR is funded

    need to be provided to the Vice Dean for Research for SOM proposals and the Vice President

    for Research or designee for all other proposals for signature. For SOM Proposals please send

    the form and letter to: som-resadmin@case.edu

    3 When the PI of the STTR application is employed by CWRU as a faculty or staff member and is

    committing effort as PI of the SBC’s STTR proposal. The purpose of this form is to inform the

    University of the faculty member’s intention to commit effort on a small business grant for a

    SBC with which he/she has a formal relationship. NOTE: If the grant is funded the NIH requires

    a letter from the PI addressed to the SBC verifying commitment, specifying assets or services

    the PI with contribute, the PI’s remuneration and indication that the PI and SBC has reached an

    agreement on proprietary interests for the project. This form is to be submitted to the Vice

    Dean for Research for SOM proposals and by the Vice President for Research or designee for all

    other proposals.

    Note: If the faculty member only has a relationship with the small business as a consultant this form does not need to be completed.

    SMALL BUSINESS INFORMATION

    Name & Contact Information of a Corporate Official of the Small Business:

    eURF# (required):

    PI of the SBIR/STTR Grant Proposal:

    SBIR/STTR Routing (March 2013)

PI’s Title:

    PI of SBIR/STTR primary employer:

    Grant’s Title:

    PI of the Subcontract to CWRU if applicable:

    Title of CWRU PI:

    Primary Employment of CWRU PI:

    Proposed Start Date: Project Duration:

    Employment: Explain your employment relationships if any (at the time of Pre and Post award) with the Small Business:

    Reporting Relationship: Explain your reporting relationships (if any) with the PI of the grant and the Small Business:

    Intellectual Property (IP):

    Explain if any CWRU’s IP is involved:

    Describe if there will be any IP developed either independently or in collaboration with the Small Business:

    If you are affiliated with other institutions (CCF/MH/UH/VA/Small Business), please give the contact information for your Technology Transfer Office:

    Financial Interest: Explain your financial interests in the Small Business:

SBIR/STTR Routing (March 2013)

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