Sponsor Request Form

This form is for use of adding a sponsor to appear in electronic systems for a research award, DSB, eGrants or eIRB.

Should this be for a Subrecipient in eGrants, you will also need to provide the DUNS number at the bottom of the form.

*Indicates a required field

Add Change Reactivate (Choose One)

Please circle all which apply below:

DSB Sponsor Y or N	eGrants - Sponsor or Subrecipient (Section 10.1)	eIRB or Velos Y or N

If Subrecipient is chosen, see note at bottom

PeopleSoft Sponsor Number:

(Only required if changing sponsor or adding location)

*Requester:	Phone:	Dept:

General Information

Effective Date: (mm/dd/yyyy):

This date will be the start of the current Fiscal Year unless a different date is entered. A Fiscal Year begins on 9/1.

*Sponsor Legal Name (40-character limit):

Preferred short name or acronym (10-character limit):

*Address Location

Location # (if known) :

Country (5-character limit):

Address Line 1 (55-character limit):

Address Line 2 (55-character limit):

Address Line 3 (55-character limit):

City (30-character limit):

State (6-character limit):

Zip Code (12-character limit):

*Select Sponsor Type (Choose one if known)

Academic (ACAD)	Institutional (INST)	Public: State of Texas (STTX)

Public: Federal (FEDL) Public: Local (LOCL)

Industry: For-Profit (INDU) Private: Non-Profit (NONP)

*Other Essential Information (If applicable)

Federal Foreign Letter of Credit

Letter of Credit Sponsor (Enter in Sponsor Code or Name):

*For Subrecipient please provide DUNS #

E-mail Form To: sponsors@utsouthwestern.edu