Principal Investigator Intake Form

Please complete one checklist per active award. This checklist will assist and ensure all information relating to the active award can be successfully transferred to UT Southwestern. For additional inquiries regarding pending or active awards, SPAOutreach@UTSouthwestern.edu SPA.

First Name*Required × Error: A field is missing data or special characters were used. Please correct.

Last Name*Required × Error: A field is missing data or special characters were used. Please correct.

PI Cell Phone (123-456-7890)*Required × Error: A field is missing data or special characters were used. Please correct.

Personal Email Address (you@someplace.com)*Required × Error: A field is missing data or special characters were used. Please correct.

PI Email (Relinquishing Institution) (you@someplace.com)*Required × Error: A field is missing data or special characters were used. Please correct.

Institution Transferring From*Required × Error: A field is missing data or special characters were used. Please correct.

Relinquishing Institution Department Administrative Contact Name*Required × Error: A field is missing data or special characters were used. Please correct.

Relinquishing Institution Department Administrative Contact Phone (123-456-7890) × Error: A field is missing data or special characters were used. Please correct.

Relinquishing Institution Department Administrative Contact E-Mail (you@someplace.com) × Error: A field is missing data or special characters were used. Please correct.

Relinquishing Institution Grants and Contracts Contact × Error: A field is missing data or special characters were used. Please correct.

Relinquishing Institution Grants and Contracts Contact Phone × Error: A field is missing data or special characters were used. Please correct.

Relinquishing Institution Grants and Contracts Contact E-Mail × Error: A field is missing data or special characters were used. Please correct.

eRA Commons Username*Required × Error: A field is missing data or special characters were used. Please correct.

UTSW Title*Required × Error: A field is missing data or special characters were used. Please correct.

UTSW Department or Center*Required × Error: A field is missing data or special characters were used. Please correct.

UTSW Start Date*Required ×Please enter a date in the correct format (MM/DD/YYYY)

UTSW Employee ID (if received) × Error: A field is missing data or special characters were used. Please correct.

Protocol Information (check all that apply)

*Required Human Subjects are involved
Human Embryonic and/or Induced Pluripotent Stem Cells
Radioactive Material will be involved
X-ray Producing Equipment will be involved
IP and Patent Information
Vertebrate Animals are involved
Biohazardous materials/recombinant DNA will be involved
Infectious Agents or Biological Toxins will be involved
Lasers will be involved
Not Applicable
× Error: A field is missing data or special characters were used. Please correct.

Will any material be provided from the original (relinquishing) institution?*Required

Yes No × Error: A field is missing data or special characters were used. Please correct.

Will equipment be transferred to UTSW?*Required

Yes No × Error: A field is missing data or special characters were used. Please correct.

Does this project involve subaward(s)?*Required

Yes No × Error: A field is missing data or special characters were used. Please correct.

If yes, has the PI notified the subawardee(s) of the transfer?

Yes No × Error: A field is missing data or special characters were used. Please correct.

Question, comment or request × Error: A field is missing data or special characters were used. Please correct.

Are any subawards with a foreign entity?

Yes No × Error: A field is missing data or special characters were used. Please correct.

Are there any Foreign Affiliations, Appointments, Collaborations, Resources, etc (paid or non-paid) associated with any research projects*Required

Yes No × Error: A field is missing data or special characters were used. Please correct.

If yes, please list below (include grant number and paid or non-paid) × Error: A field is missing data or special characters were used. Please correct.

Turest Service

× Error: A field is missing data or special characters were used. Please correct.

*Required