I certify that the statements herein are true, complete and accurate to the best of my knowledge. I agree to accept responsibility for the scientific conduct of the project, to comply with UVM and FAHC terms and conditions and to provide the required progress reports if a grant is awarded as a result of this application. I will adhere to standard "Good Clinical Practices" in carrying out these studies. If pending external grants for the same work are funded during the course of an RFD Award, unexpended balance will be returned to the Office of Patient Oriented Research. In addition, I understand that no studies involving humans can take place without IRB approval.

I declare that _____ I do / ______ do not have a conflict of interest in carrying out this proposal.

If yes, explain reasons (e.g. consulting, stock ownership, patent ownership, etc.).

Signature of Principal Investigator: ___________________________