C-1
	APPENDIX C 
PROPOSAL PREFATORY MATERIALS

TABLE OF CONTENTS					PAGE

NOTICE OF INTENT (NOI) TO PROPOSE			C-2

RESEARCH PROPOSAL COVER SHEET				C-3

RESEARCH PROPOSAL SUMMARY				C-4

RESEARCH PROPOSAL BUDGET SUMMARY			C-5

BUDGET SUMMARY INSTRUCTIONS 				C-6

RESEARCH PROPOSAL PERSONNEL SUMMARY			C-7

INVESTIGATOR'S CURRENT AND PENDING RESEARCH SUPPORT	C-8

CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND 
OTHER RESPONSIBILITY MATTERS PRIMARY COVERED 
TRANSACTIONS						C-9

CERTIFICATION REGARDING DRUG-FREE WORKPLACE 
REQUIREMENTS GRANTEES OTHER THAN INDIVIDUALS		C-10

CERTIFICATION REGARDING LOBBYING			C-11

SPACE PHYSICS EDUCATION OUTREACH (SPEO) COVER SHEET	C-12

NOTICE OF INTENT (NOI) TO PROPOSE

NRA 96-OSS-03 SPACE PHYSICS NEW MISSIONS CONCEPTS PROGRAM

• Cosmic and Heliospheric Physics
• Solar Physics
• Magnetospheric Physics
• Ionospheric, Thermospheric, Mesospheric Physics
• Multidisciplinary (specify)

• Suborbital: Sounding Rocket Balloon (Short or Long-Duration)
• Orbital: Earth orbit Other (specify; e.g., "Mercury orbit"; "Deep space"; etc.)

EDUCATION OUTREACH:

Intent to submit a Space Physics Education Outreach (SPEO) Supplement? YES / NO
(neither commits to submission or non submission of an educational proposal) DESCRIPTIVE TITLE OF INVESTIGATION:

PRINCIPAL INVESTIGATOR: Name/Title
Institutional address including telephone, fax number and E-mail address

CO-INVESTIGATOR(S) (to extent known by NOI deadline): Name(s) and institutional addresses(s)

STATEMENT OF OBJECTIVES OF THE INTENDED INVESTIGATION: (not to exceed ~one half page)

Submit this NOI by any one of the following processes, though use of electronic mail (option 3) is preferred. Acknowledgment of receipt will be sent by mail.

By postal or express mail to: NASA Space Physics New Concepts Program

	Jorge Scientific Corporation
	Suite 700
	400 Virginia Avenue, SW
	Washington, DC 20024            USA
  Contact for commercial mail:		Ms. Susan Borden
		202/554-2775
  By facsimile to:			202/554-2970 or 4923
  By electronic mail to: 		hlancast@leda.hq.nasa.gov

RESEARCH PROPOSAL COVER SHEET
(use additional pages as required)

NRA 96-OSS-03 SPACE PHYSICS NEW MISSION CONCEPTS PROGRAM

• Cosmic and Heliospheric Physics
• Solar Physics
• Magnetospheric Physics
• Ionospheric, Thermospheric, Mesospheric Physics
• Multidisciplinary (specify)

• Suborbital: Sounding Rocket Balloon (Short or Long-Duration)
• Orbital: Earth orbit Other (specify)

(Neither commits to submission or non submission of an educational proposal.)

DESCRIPTIVE TITLE OF INVESTIGATION:

PRINCIPAL INVESTIGATOR: Name/Title
Institutional address including telephone, fax number and E-mail address Signature

CO-INVESTIGATOR(S): (if any) Name(s) and Institutional Addresses(s)

INSTITUTIONAL AUTHORIZATION: Name/Title Institutional address including telephone Authorizing Signature/Date

BUDGET SUMMARY:		1st Year	2nd Year*	Total

	  Research Task ($K):	________	________		

	  SPEO Supplement ($K)*:________	________		
	
* As appropriate and required.

RESEARCH PROPOSAL SUMMARY

DESCRIPTIVE TITLE OF INVESTIGATION:
(use same title as on Cover Sheet)

PRINCIPAL INVESTIGATOR / INSTITUTION:

CO-INVESTIGATOR(S) / INSTITUTION(S):

___________________________________________

Special Instructions. The Proposal Summary should contain the following information, should not exceed one page in total length, and may also serve as the Abstract of the proposal:

(a) Overall objectives and strategy of the proposed work;

(b) A brief description of what will be done and plan of activities;

(c) Perceived relevance of proposed mission concept to NASA's space physics programs

RESEARCH PROPOSAL BUDGET SUMMARY

(see instructions below)

FROM: _________ to _________  (year ___ of a ___ year request)

TITLE OF INVESTIGATION:

PRINCIPAL INVESTIGATOR / INSTITUTION:
			   NASA USE ONLY
			    A		B		C
1.  Direct Labor (salaries, wages, and	fringe benefits)
			___________ __________  ____________

2.  Other Direct Costs:
     a.  Subcontracts	___________ __________  ____________

     b.  Consultants	___________ __________	____________

     c.  Equipment	___________ __________	____________

     d.  Supplies	___________ __________	____________

     e.  Travel		___________ __________	____________

     f.  Other		___________ __________	____________

3.  Indirect Costs	___________ __________	____________

4.  Other Applicable Costs
			___________ __________ ____________

5.  Subtotal   Estimated Costs	
			___________ __________	____________

6.  Less Proposed Cost Sharing	
			___________ __________	____________

7.  Carryover Funds (if any)
    a.  Anticipated amount
		 	___________ __________	____________

	b.  Amount used to reduce budget	
			___________ __________	____________

8.  Total Estimated Costs	
			___________  __________	XXXXXXXX

APPROVED BUDGET		XXXXXXX	     XXXXXXX	____________
____________________________________________________________

--------- ADDITIONAL INSTRUCTIONS ON FOLLOWING PAGE ---------

BUDGET SUMMARY INSTRUCTIONS

1. Direct Labor (salaries, wages and fringe benefits). Enclosures should list number and titles of personnel, amount of time devoted to the grant, and rates of pay.

2. Other Direct Costs.

a. Subcontracts - Enclosures should describe the work to be subcontracted, estimated amount, recipient (if known), and the reason for subcontracting this effort.

b. Consultants - Identify consultants to be used, why they are necessary, time to be spent on the project, and rates of pay.

c. Equipment - List separately and explain the need for items of equipment exceeding $1,000. Describe the basis for the estimated cost.

d. Supplies - Provide general categories of needed supplies, the method of acquisition, estimated cost, and the basis for the estimate.

e. Travel - List the proposed trips individually, describe their purpose in relation to the grant, provide dates and destinations where known, and explain how the cost for each was derived.

f. Other - Enter the total of any other direct costs not covered by 2.a through 2.e. Enclose an itemized list explaining the need for each item and the basis for the estimate.

3. Indirect Costs. Identify indirect cost rate(s) and base(s) as approved by the cognizant Federal agency, including the effective period of the rate. If unapproved rates are used, explain why and include a computational basis for the indirect expense pool and corresponding allocation base for each rate.

4. Other Applicable Costs. Enter the total of any other applicable costs not covered by instructions 1 through 3. Enclose an itemized list explaining the need for each item and the basis for the estimate.

5. Subtotal -- Estimated Costs. Enter the sum of items 1, 2.a through 2.f, 3, and 4.

6. Less Proposed Cost Sharing (if any). Enter the amount proposed, if any. If cost sharing is based on specific cost items, identify each item and amount in enclosures.

7. Carryover Funds (if any). Enter the dollar amount of any funds that are expected to be available for carryover from the prior budget period.

8. Total Estimated Costs. Enter the total after subtracting items 6 and 7 from item 5.

RESEARCH PROPOSAL PERSONNEL SUMMARY

TITLE OF INVESTIGATION:

PRINCIPAL INVESTIGATOR AND INSTITUTION:

1.	Senior personnel (list name(s)).......	WY____	$________
2.	Postdoctoral associate (list name(s))..	WY____	$________
3.	Student(s) (give number)...............	WY____	$________
4.	Technical support staff (give number)..	WY____	$________
5.	Other.................................. WY____	$________
6.	TOTAL..................................	WY____	$________

YEAR 2: SUMMARY OF PERSONNEL

INVESTIGATOR'S CURRENT AND PENDING RESEARCH SUPPORT

1. For the Principal Investigator and each Co-Investigator, provide separately for categories A and B the following information:

				Source of support
				Project title and sentence
					 abstract
				Award amount
				Period covered by award
				Work-year commitment of the
					 proposed Investigator.

A. Currently supported research project(s) that will be active during FY 1996 (October 1, 1995, through September 30, 1996).

B. Research project(s) for which support is pending (including this proposal).

2. List the name of any other funding sponsor to which this proposal has been or will be contemporaneously submitted, including relevant dates.

Certification Regarding Debarment, Suspension, and Other Responsibility Matters Primary Covered Transactions

(1) The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals:

(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;

(b) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

(c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and

(d) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default.

(2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.

	Institution 			Principal Investigator 


	Name and Title of Authorized Representative


	Signature			Date

Certification Regarding Drug-Free Workplace Requirements Grantees Other Than Individuals

The grantee certifies that it will provide a drug-free workplace by:

(a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the grantee¹s workplace and specifying the actions that will be taken against employees for violation of such prohibition;

(b) Establishing a drug-free awareness program to inform employees about‹

(1) The dangers of drug abuse in the workplace;

(2) The grantee's policy of maintaining a drug-free workplace;

(3) Any available drug counseling, rehabilitation, and employee assistance programs; and

(4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;

(c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a);

(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will‹

(1) Abide by the terms of the statement; and

(2) Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction;

(e) Notifying the agency within ten days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction;

(f) Taking one of the following actions, within 30 days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted

(1) Taking appropriate personnel action against such an employee, up to and including termination; or

(2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency;

(g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e) and (f).

Institution				Principal Investigator 


Name and Title of Authorized Representative


Signature				Date

Certification Regarding Lobbying

(a) No Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, in connection with making of any Federal grant, the entering into of any cooperative, and the extension, continuation, renewal, amendment, or modification of any Federal grant or cooperative agreement;

(b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting an officer or employee of any agency, Member of Congress, an or an employee of a Member of Congress in connection with this Federal grant or cooperative agreement, the undersigned shall complete Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.

(c) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subgrants, contracts under grants and cooperative agreements, and subcontracts), and that all subrecipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by S1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less that $10,000 and not more than $100,000 for each such failure.

________________________________________________________________
Organization Name			AO or NRA Number and Name


________________________________________________________________
Printed Name and Title of Authorized Representative


________________________________________________________________
Signature						Date


________________________________________________________________
Printed Principal Investigator Name		Proposal Title

SPACE PHYSICS EDUCATION OUTREACH (SPEO) COVER SHEET

NRA 95-OSS-NN SPACE PHYSICS NEW MISSION CONCEPTS PROGRAM

DESCRIPTIVE TITLE OF SPEO ACTIVITY:

PRINCIPAL INVESTIGATOR: (must be same as parent research proposal)

	Name/Title
	Institutional address including telephone
		and e-mail address
	Signature/Date

	Name and Institutional Addresses

	Name/Title
	Institutional address including telephone
	Authorizing Signature/Date

	1st Year	2nd Year	Total	

	________	________	________