Research Corporation of the University of Hawaiʻi

Direct Project Request (State Department/Agency)

Applicant Information Date: _________________________

Department/Agency: ____________________________________________________________

Address: ______________________________________________________________________

City: ________________________________ _ State: ____________ Zip code: ______________

Name of primary contact: ____________________________ Title: _______________________

Email: ___________________________________________ Phone: _______________________

______________________________________________________________________________

1. The purpose of RCUH includes, but is not limited to, the promotion of all educational, scientific, and literary pursuits. Please explain how any of the below, or all, apply to the project(s) requesting RCUH services and also how these project(s) serve a public purpose/benefit the State of Hawaii:

• Encourages, initiates, aids, develops, and conducts training, research, and study in the physical, biological, social sciences, humanities, and all other branches of learn-ing;
• Encourages and aids in the education and training of persons for the conduct of training, investigations, research, and study;
• Furnishes the means, methods, and agencies by which the training, investigation, re-search, and study may be conducted;
• Assists in the dissemination of knowledge by establishing, aiding and maintaining professorships or other staff positions, fellowships, scholarships, publications, and lectures;
• Engages in other means of making the benefits of training, investigations, research and study available to the public;
• Takes any and all other actions reasonably designed to promote these purposes in the interest of promoting the general welfare of the people of the State.
_____________________________________________________________________________________________________________________________________________________________________________________________________________________
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Rev July 2020
2. Project Title: ____________________________________________________________
Principal Investigator: _____________________________________________________
Email: ______________________________________ Phone: _____________________
Project Period:_______________________________ Amount: ____________________

Brief Description of Project: ________________________________________________ ______________________________________________________________________________________________________________________________________________

3. Project scope of work and deliverables: Attachment 1 (will be made part of the pro-ject agreement if project is accepted)

4. Attach Governor’s approval.

5. Source of funding.

Federal agency $ __________________________
State agency $ __________________________
Other $ __________________________
6. Will this project involve any of the following? Check all that apply and explain:
¬___Construction ________________________________________________
___Exporting of Tech Equip/Data ________________________________________________
___Firearms ________________________________________________
___Foreign Operations ________________________________________________
___Hazardous Materials ________________________________________________
___Helicopter/Aircrafts ________________________________________________
___HIPAA (Protected Health Info) ________________________________________________
___Human Subjects ________________________________________________
___Live Animals ________________________________________________
___Marine/Diving Activities ________________________________________________
___Subcontracts ________________________________________________

7. Does this project have existing employees? Yes ___ No___. If yes, is the intent for them to become RCUH employees? Yes ___ No ___.

Note: RCUH reserves the right to evaluate incumbent employees and determine ap-propriateness of conversion to RCUH.
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Personnel requirements/brief job description:
Position Description
_____________________ ________________________________________________
_____________________ ________________________________________________
_____________________ ________________________________________________
_____________________ ________________________________________________
_____________________ _______________________________________________

Direct Projects accepted by RCUH must comply with RCUH policies and procedures. Please refer to www.RCUH.com

Certification

I certify that I am an authorized personnel of the Department/Agency named above, and that the information provided on this request is true and correct.

Signature: ________________________________________________ Date: ________________

Print name: ____________________________________ Title: ___________________________

**********************************RCUH USE ONLY******************************

Direct Project request has been reviewed and recommended as follows:

Initials Date Comments

Director of HR Approve/Disapprove ______ ____________ ______________________

Director of Finance Approve/Disapprove ______ ____________ ______________________

Approve/Disapprove Direct Project request:

______________________________________________________________________________
Executive Director Date
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Attachment 1

SCOPE OF SERVICES

RCUH shall provide administrative services and employ staff to support the Department to per-form its scope of work and deliverables, described as follows:

Program Budget:

Salaries ________________
Fringe ________________
Supplies ________________
Travel ________________
Equipment ________________
Other ________________
__________ ________________
__________ ________________
__________ ________________
__________ ________________
__________ ________________

Total Direct Costs ________________

RCUH Indirect Costs (____ %) ________________

Total ________________

Source of fund: _________________________________ $_______________________
_________________________________ $_______________________