CONHI CRS Grant Appointment Request Form

FOR CRS AUTHORIZED USERS ONLY

This form is required to be completed and submitted by the PI or an authorized representative in the Center for Research and Scholarship (CRS) to initiate effort appointment requests for an individual that is approved to devote time/effort on externally funded sponsored projects awarded to UT Arlington. Please complete a request form for each individual devoting effort to the project. Once this form is completed by the CRS, it will be routed to the assigned CONHI Business Office payroll representative to process a UTShare eForm for salary redistribution.

NOTE: Due to award terms and conditions, any change request not reviewed/approved by CRS staff in conjunction with the PI on record is prohibited.

For questions, please email crs@uta.edu or call 817-272-5773. Thank you.

Center for Research Search and Scholarship, a division in the College of Nursing and Health Innovation.

I. Individual Devoting Effort
Name Name * First Last
Email *
Type of Request *

Type of Request New appointment to sponsored project Change in UTShare project number due to carryforward. Project staff effort must be changed to new project number. (Ex. PY2, PY3, etc.) Change effort percentage on existing project Remove from sponsored project to an institutional cost center to be determined by the assigned CONHI payroll contact.
Salary Distribution *

Salary Distribution 12-months (staff) or 9-months (faculty) annual. 3-months, Summer (June 1 to August 31) for current year of project. For employees with faculty status only. 1-month appointment or less. Not applicable to this request.
II. Authorized CRS Representative
Name Name First Last
Email
III. Authorized Payroll Representative
Department of Kinesiology and College of Nursing.
NOTE: Due to award terms and conditions, any change request not reviewed/approved by CRS staff in conjunction with the PI on record is prohibited. *

Department of Kinesiology and College of Nursing.
NOTE: Due to award terms and conditions, any change request not reviewed/approved by CRS staff in conjunction with the PI on record is prohibited. Kinesiology - Cynthia Stringer (New appointments for Kinesiology only; WILL NOT process salary re-distribution requests) Nursing and Kinesiology - Andrea Patrick (Salary re-distribution for Nursing and Kinesiology; new appointments for Nursing only)
IV. Sponsor Information
Title of Sponsored Project *
Sponsoring Agency *
Date Award Setup Paperwork Received From OGCS/Post Award Administration Date Award Setup Paperwork Received From OGCS/Post Award Administration * / MM / DD YYYY
Is the award setup date above over 90 days from the award start date? *

Is the award setup date above over 90 days from the award start date? Yes - No explaination required from CONHI since award setups are not processed at the college level. No
Effective Date of Effort Per Award Effective Date of Effort Per Award * / MM / DD YYYY
End Date of Effort Per Award End Date of Effort Per Award * / MM / DD YYYY
V. Approved Project Effort
Project 1:
UT Share Project Number *
Effort Percentage/Calendar Months
Approved Salary * $ Dollars . Cents
Approved Fringe Benefits * $ Dollars . Cents
Is Cost Share required due to salary cap exceeds sponsors limit? If YES, please provide Cost Share Cost Center Speedtype numbers below issued by Post Award. *

Is Cost Share required due to salary cap exceeds sponsors limit? If YES, please provide Cost Share Cost Center Speedtype numbers below issued by Post Award. YES NO
Cost Share Cost Center Speedtype Numbers
Cost Share amount for this appointment. If no amount, enter zero. * $ Dollars . Cents
Project 2:
UT Share Project Number
Effort Percentage/Calendar Months
Approved Salary $ Dollars . Cents
Approved Fringe Benefits $ Dollars . Cents
Project 3:
UT Share Project Number
Effort Percentage
Approved Salary $ Dollars . Cents
Approved Fringe Benefits $ Dollars . Cents
Project 4:
UT Share Project Number
Effort Percentage
Approved Salary $ Dollars . Cents
Approved Fringe Benefits $ Dollars . Cents
Project 5:
UT Share Project Number
Effort Percentage
Approved Salary $ Dollars . Cents
Approved Fringe Benefits $ Dollars . Cents
VI. Supporting Documentation
Supporting Documentation

Attach Files
Additional Comments
VII. Authorization
As the official Principal Investigator on record by the sponsor, I authorize the Center for Research and Scholarship staff to review for compliance as approved by the sponsoring agency and process to a CONHI Business Office payroll representative as indicated above for salary redistribution on my behalf. Thank you. *

As the official Principal Investigator on record by the sponsor, I authorize the Center for Research and Scholarship staff to review for compliance as approved by the sponsoring agency and process to a CONHI Business Office payroll representative as indicated above for salary redistribution on my behalf. Thank you. Yes, I authorize.

CONHI CRS Grant Appointment Request Form

CONHI CRS Grant Appointment Request Form

I. Individual Devoting Effort

II. Authorized CRS Representative

III. Authorized Payroll Representative

IV. Sponsor Information

V. Approved Project Effort

Project 1:

Project 2:

Project 3:

Project 4:

Project 5:

VI. Supporting Documentation

VII. Authorization