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Principal Investigator Exception Status Request

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Name:  _______________________
Current Academic Title:  ______________
Department:  __________________________
Campus Address:  __________________________
Email:  ___________________
Phone:  __________ Fax:  __________


Please allow this individual to serve as Principal Investigator/Co-Principal Investigator.
This exception applies to:

Proposal Title:   __________________________
Agency:   ____________________________
Other Investigators (if any):   __________________
Project number (if available):   __________________
Date Proposal Submitted:   _______________
Date Proposal Due:   _______________
Please justify the request for exception:   ___________________________


Requested by
Department Chair: _________ _____________ ______
Name Signature Date
Assoc. Dean for Research: Roshan Bastani  _____________ ______
Name Signature Date
Or
Dean:		 Linda Rosenstock  _____________ ______
Name Signature Date



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