(rev 10/99)   
Louisiana Transportation
Research Center
Research Proposal	(LTRC USE ONLY)	Page 1
DATE OF RECEIPT	
	LTRC PROJECT NO.	
	STATE PROJECT NO.	
PART I: GENERAL INFORMATION	
1. AMOUNT REQUESTED (SAME AS PART III)

$ 	2. DURATION OF PROJECT

ANTICIPATED START DATE 	 ACTUAL START DATE 	
DURATION IN MONTHS 	 ENDING DATE 	
	
3. TITLE OF RESEARCH PROPOSAL (PLEASE BE BRIEF)

4. NAME AND BUSINESS ADDRESS OF PROPOSER
(INDIVIDUAL, INSTITUTION, FIRM, OR CORPORATION)
	5. NAME, TITLE, AND MAILING ADDRESS OF PRINCIPAL INVESTIGATOR
(BEARING SCIENTIFIC RESPONSIBILITY)
	
TELEPHONE NUMBER AND EXTENSION OF BUSINESS OFFICE
	TELEPHONE NUMBER AND EMAIL ADDRESS OF PRINCIPAL INVESTIGATOR
	
6. MAJOR SUB-DIVISION THAT WILL CONDUCT RESEARCH
	7. NAME AND TITLE OF CO-PRINCIPAL INVESTIGATOR
	
PART II: APPROVAL	
RECOMMEND BY THE ASSOCIATE DIRECTOR LTRC, RESEARCH

Tyson Rupnow, Ph.D., P.E.	DATE
	
RECOMMENDED BY THE DIRECTOR, LTRC

Samuel B. Cooper, Jr., Ph.D., P.E.	DATE
	
RECOMMENDED BY CHAIRMAN,  LTRC POLICY COMMITTEE

Janice P. Williams, P.E.	DATE
	
RECOMMENDED BY IMPLEMENTATION SPONSOR

	DATE	
APPROVED BY THE DOTD SECRETARY

Shawn D. Wilson, Ph.D.	DATE
	
APPROVED MODIFICATIONS:
(LTRC USE ONLY)	

PART III AMOUNTS REQUESTED FOR PROJECT (For period of time indicated in Part 1 Item 2)	Page 2	
ITEM		Percent of Time
on Project	FUNDS (Omit Cents)	
			Tot. Proj. Cost	Fiscal Year	Fiscal Year	Fiscal Year	Remaining	
1.	PERSONNEL

(List all positions and persons incl. principal and co-researcher.
Amounts requested must not exceed proportion of total salary computed from % of time spent based on a 40 hour work week. Include graduate students if any.)								

								

								
								
	Total Salaries and Wages							
	Plus 	 % for Employee Benefits							
	Total Personnel Costs							
2.	NON EXPEND-ABLE EQUIPMENT

(Itemize)							

							
							
	Total Non-Expendable Equipment						
3.	CONSUMABLE SUPPLIES

(Itemize)							

							
							
	Total Consumable Supplies						
4.	TRAVEL

(Itemize)							

							
	Total Travel						
5.	OTHER EXPENSES

(Itemize)							

							
	Total Other Expenses						
6.	TOTAL DIRECT COSTS						
7.	TOTAL INDIRECT COSTS 
(attach documentation to substantiate indirect cost rate used and method of application in Part VIII)						
8.	TOTAL COSTS (Total of 6 & 7)						

Page 3
Part IV - 	BIOGRAPHICAL SKETCHES - Provide brief sketches for professional personnel already selected who are to be actively engaged in this project.  The following questions should be completed with co-principal researcher immediately following principal researcher, followed by other professional personnel.	
NAME OF PRINCIPAL INVESTIGATOR	TITLE	
		
DATE OF BIRTH	PLACE OF BIRTH	SEX	CITIZENSHIP	9  US
9  OTHER (SPECIFY)	
				
EDUCATION	DEGREE	INSTITUTION CONFERRING	FIELDS	YEAR	
(DEGREES CONFERRED - IDENTIFY HONORARY DEGREES IN FIELD)					

					
OTHER RESEARCH TRAINING AND EXPERIENCE, PARTICULARLY IN AREA COVERED BY THIS APPLICATION	LOCATION	NATURE	YEAR	

				

FIELDS OF PRESENT MAJOR SCIENTIFIC INTEREST IN ORDER OF CHOICE
		
NAME OF C0-PRINCIPAL INVESTIGATOR	TITLE	
		
DATE OF BIRTH	PLACE OF BIRTH	SEX	CITIZENSHIP	9  US
9  OTHER (SPECIFY)	
				
EDUCATION	DEGREE	INSTITUTION CONFERRING	FIELDS	YEAR	
(DEGREES CONFERRED - IDENTIFY HONORARY DEGREES IN FIELD)					

					
OTHER RESEARCH TRAINING AND EXPERIENCE, PARTICULARLY IN AREA COVERED BY THIS APPLICATION	LOCATION	NATURE	YEAR	

				

FIELDS OF PRESENT MAJOR SCIENTIFIC INTEREST IN ORDER OF CHOICE
		
NAME	TITLE	
		
DATE OF BIRTH	PLACE OF BIRTH	SEX	CITIZENSHIP	9  US
9  OTHER (SPECIFY)	
				
EDUCATION	DEGREE	INSTITUTION CONFERRING	FIELDS	YEAR	
(DEGREES CONFERRED - IDENTIFY HONORARY DEGREES IN FIELD)					

					
OTHER RESEARCH TRAINING AND EXPERIENCE, PARTICULARLY IN AREA COVERED BY THIS APPLICATION	LOCATION	NATURE	YEAR	

				

FIELDS OF PRESENT MAJOR SCIENTIFIC INTEREST IN ORDER OF CHOICE

Page 4	

PART V	
TITLE VI STATEMENT	
	
The attention of the proposed research contracting agency or institution is directed to the need to comply with the requirements of Title VI of the Civil Rights Act of 1964.

                                                                        (Name of Contracting Agency) acknowledges that we are aware of the requirements of Title VI and will not discriminate on the basis of race, creed, sex, or national origin and will endeavor to involve the members of minority groups in the conduct of the proposed contract research study.

TECHNICAL RESEARCH PROPOSAL	
	
Details of the proposed plan and other necessary data shall be typed (double-spaced) in accordance with the sequence and requirements defined in Chapter 2 of the LTRC Research Procedure Manual.  Continue numbering pages in sequence for the entire proposal using the continuation sheet.

PART VI	
SUMMARY OF PROPOSED RESEARCH