Proposal Sign-Off Form Page 3

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Section A: Additional Signatures Certification
new, competing, and non-competing (progress reports) applications
In signing below the following Investigators certify that:
they have submitted an annual conflict of interest disclosure statement;
- there are no new financial interests to report (if there are new financial interests that have not been disclosed, the
investigator must report these prior to proposal submission); and
- they are not currently debarred or suspended from doing business with the federal government or excluded from
Medicare or other federal/state health care programs, or that they are not currently in default on any federal student
- In addition, the Investigators understand that any false, fictitious, or fraudulent statements or claims made in the
accompanying submission may subject the Investigators personally to criminal, civil, or administrative penalties. The
Investigators agree to accept responsibility for the scientific conduct of the project and to provide the required progress
reports if a grant is awarded as a result of this application.
Role on Project
(e.g. PI, Res. Assoc.)
Form Rev. 01/01/15
Page 3


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