Attachment I (Form AP-5)

Research Advance Request Form

Accounts Payable Office

Submit completed forms to: AVP Research Office JCK 489

Instructions: Complete all fields. Include this form with any required supporting documentation. Form must be submitted

10 days prior to the requested date in field 13 below. For more information on process and requirements, contact the AVPR Office at 5-2314. If related to foreign travel, presidential travel approval is required 45 days prior to departure.

AP Use: Funds Commitment No.

AP Use: Advance Document No.

1. Principal Investigator 2. SAP Vendor No.

3. Project

4a. Use of Funds Start Date __________________________

4b. Use of Funds End Date ___________________________

4c. Grant Start Date _____________________________ 4d. Grant End Date ________________________________________

Estimated

5. Advance Type One Time Revolving -

Payments Human Subjects Complete #6

6. Human Subjects IRB # __________________________ Approval Date _________________________

7. Rationale for Advance Request (If additional space is needed, attach a separate document.)

GL Expense Code

A
B
C
D
E
	14. Total

8. Cost Center 9. Fund 10. Internal Order 11. Sponsored Class

12. Amount

13. Date Advance Needed

15. Contact Person Phone

I accept responsibility for all cash and cash equivalents received under this advance. I will provide a reconciliation including receipts and all other required documentation within 30 days of the Use of Funds end date shown in 4b above. If I fail to provide the required reconciliation and required support documentation, I understand that I will be contacted to repay the university for any unsubstantiated amount of this advance. Should the unsubstantiated amount not be repaid within 60 days of the Use of Funds end date shown in 4b above, the unsubstantiated amount will be reported to the Payroll and Tax Compliance Office for inclusion as additional income on the requesting investigator’s W-2 in accordance with IRS requirements. Funds received will be used in accordance with the principles established in OMB Circular A-21 regardless of the source of funding.

16. Approvals Signature Printed Name Date

Requesting

Investigator

Academic Chair1

(if $2,500 or more)

Academic Dean

(if $10,000 or more)

Office of Sponsored

Programs2

Assistant VP for

Research Approval3

1 If the approver is the requesting investigator, approval is required from at least one level higher than the investigator.

2 Office of Sponsored Programs approval required on all sponsored projects.

3 Assistant Vice President Research approval required on all human subject advances and Research Enhancement Program (REP) funded projects.

AP Internal Coding: Bank: 10 General Ledger: 101120 Fund: 2025031000

Effective 1/01/13