APPENDIX
III
INFORMATION
ABOUT
PRINCIPALINVESTIGATORSIPROJECTDIRECTORS
FourthAdditionalPI/POThirdAdditionalPI/PO
Second
AdditionalPI/PO
Submit
only
ONE
copy
of
this.form
with
your
proposal.Attach
it
ontop
of
thecoverpage
of
thecopy
of
your
proposal
that
bears
theoriginalsignatures.Leave
the
back
of
thepageblank.
Do
not
includethisformwith
any
of
theothercopies
of
your
proposal,
as
this
may
compromisetheconfidentiality
of
theinformation.
Please
check
theappropriateanswers
to
eachquestionfor
all
principalinvestigator(s}/project
director(s}
listed
on
thecover
page,
using
the
sameorder
inwhichtheywere
listed
there:
PrincipalFirstInvestigator/AdditionalProjectDirectorPI/PO1.IsthispersonFemale
0000
0
Male
I]J
0
0
0
0
2.
IsthispersonaU.S.Citizen
0000
0
PermanentResident
[il
0000
Other
non-U.S.Citizen
00
0
00
D·
oo
o
oooo
ooo
o
3.
Which
one
of
thesecategoriesbestdescribesthisperson'sethnic/racialstatus?(Ifmorethanonecategoryapplies,
use
thecategorythat
most
closelyreflectstheperson'srecognitioninthecommunity.)
American
Inc;lian
or
000
AlaskanNativeAsian
89·
00
Black,
not
ofHispanicOrigin
000
Hispanic
000
PacificIslander
000
White,
not
ofHispanicOrigin
000
4.
Does
thispersonhaveadisability-whichlimitsa
major
lifeactivity?
~
0
DOD
0
~
rn
DOD
0
Check
here
if
thisperson
doesnotwish
toprovidesome
or
all
of
theabove
information
00000
Required:Check
here
if
this
personis
currentlyserving(or
has
previously
served)as
PI,Co-PI
or
PO
on
any
Federally
fundedproject.
00000
AMERICANINDIANOR
~ L A S K A N
NATIVE:Apersonha'(ingoriginsinanyoftheoriginalpeoples
of
NorthAmericaand
who
maintainsculturalidentificationthroughtribalaffiliation
or
communityrecognition.ASIAN:A
person
havingoriginsinany
of
theoriginal
peoples
ofEastAsia,SoutheastAsia
or
theIndianSUbcontinent.ThisareainclUdes,for
example,
China,India,Indonesia,Japan.KoreaandVietnam.
BLACK,
NOT
OF
HISPANIC
ORIGIN:Apersonhavingoriginsin
any
oftheblackracialgroupsofAfrica.HISPANIC:A
person
ofMexican,PuertoRican,Cuban,Central
or
SouthAmerican
or
other
Spanishculture
or
origin,regardlessofrace.PACIFIC
ISLANDER:
Apersonhavingorigins
in
anyoftheorignalpeoples
of
Hawaii;theU.S.Pacificterritories
of
Guam.AmericanSamoa,
and
the
NorthernMarinas;theU.S.TrustTerritory
of
Palau;theislandsofMicronesiaandMelanesia;
or
thePhilippines.WHITE,
NOTOF
HISPANIC
ORIGIN:Apersonhavingoriginsin
any
of
theoriginalpeoplesofEurope,NorthAfrica,
or
the
MiddleEast.-Disabled:A
person
havingaphysical
or
mentalimpairment
that
substantiallylimits
oneor
more
major
lifeactivities;
who
hasarecordof
such
impairment;
or
who
isregardedashavingsuchimpairment.
WHY
THIS
INFORMATION
IS
BEING
REQUESTED:
The
FederalGovernment
hasacontinuing
commitment
tomonitortheoperation
of
itsreviewandawardprocessestoidentify
andaddressany
inequitiesbasedongender.race,ethnicity,
or
disability
of
theproposedprincipalinvestigators!project
directorsand
co-principalinvestigators.To
gather
theinformationneededforthisimportanttask,youshouldsubmita
singlecopyof
thisformwitheachproposal;·however,submission
of
therequestedinformationis
not
mandatoryandis
not
aprecondition
of
award.Anyindividual
not
wishingtosubmittheinformationshouldchecktheboxprovided
for
thispurpose.(Theexceptionisinformation
about
previousFederalsupport,the
last
questionabove.)!nformationfromthisformwill
be
retained
by
Federal
agencies
asanintegralpart
of
theirPrivacyActSystems
of
Records
In
accordance
with
thePrivacyActof1974.
Theseare
confidentialfilesaccessibleonlytoappropriateFederalagencypersonnel
and
will
be
treatedasconfidentialtothe
extent
permitted
by
law.Datasubmittedwillbeusedinaccordancewithcriteriaestablished
by
therespectiveFederal
agency
forawardinggrantsforresearchandeducation,andinresponseto
PublicLaw
99-383and42
USC
1885c.
NSF
F."".
122S(
11SlO)
23
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