Form SFN59921 "Centers of Excellence Change Request" - North Dakota

What Is Form SFN59921?

This is a legal form that was released by the North Dakota Department of Commerce - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2015;
  • The latest edition provided by the North Dakota Department of Commerce;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SFN59921 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Commerce.

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Download Form SFN59921 "Centers of Excellence Change Request" - North Dakota

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CENTERS OF EXCELLENCE CHANGE REQUEST
NORTH DAKOTA DEPARTMENT OF COMMERCE
SFN 59921 (03-15)
Instructions: Indicate the type of change you are requesting. You may select more than one. Attach the necessary
supporting documentation. *Note - Any material change must be approved by the Commission.
Name of Requesting Institution or Foundation
Project Title
Program:
COE
CORE
LD-CAP
Research ND
Research ND BIO
Fast Track
Venture Grant Phase I
Venture Grant Phase II
Enhancement
Base Realignment
1. Timeline Extension Until
a. Attach revised timeline
b. If the budget is impacted, check and complete #2 below
c. Attach a one-page summary identifying new benchmarks or modified timing of benchmarks
2. Budget Modification
a. Attach revised budget
b. Attach revised budget narrative
c. Attach a one-page summary describing any impact to operations
3. Partner Change
a. Attach a one-page summary describing reason for the change and identifying new partner(s)
b. Attach the COE Verification of Private Sector Participation Form or other document describing matching
contribution(s) and the collaboration with the Center
4. Material Change to Scope of the Project
a. Consult with the Department of Commerce to determine what supporting material should be provided
b. Check and complete any of the above or below options if impacted by the change
5. Minor change to project altering the budget <20% (Research ND, Research ND BIO, and Venture grants only)
a. Provide documentation demonstrating approval by both RU and PSP
b. Check and complete any of the above or below options if impacted by the change
6. Other
a. Attach a one-page summary describing the change(s)
b. Consult with the Department of Commerce to determine what supporting material should be provided
Submission: Change Request Forms are to be submitted electronically to the North Dakota Department of Commerce
at researchND@nd.gov.
The Change Request Form is a formal request to approve the change(s) noted above to our initial request. I certify that
the information contained herein this request is accurate to my knowledge. I further certify that I am an authorized signor
for the institution making the change request.
Center Director/PI Signature
Printed Name
Date
University Authorized Representative Signature
Printed Name
Date
Research ND & Venture Grant Phase I, II & I/II Only
PSP Authorized Signature
Printed Name
Date
For Office Use Only
Date Received
Date of Commission Action
Commission Action
Date Copy Forwarded to Center
Approved
Not Approved
Other
Administrative Action
Signature
Date
Approved
Not Approved
Other
CENTERS OF EXCELLENCE CHANGE REQUEST
NORTH DAKOTA DEPARTMENT OF COMMERCE
SFN 59921 (03-15)
Instructions: Indicate the type of change you are requesting. You may select more than one. Attach the necessary
supporting documentation. *Note - Any material change must be approved by the Commission.
Name of Requesting Institution or Foundation
Project Title
Program:
COE
CORE
LD-CAP
Research ND
Research ND BIO
Fast Track
Venture Grant Phase I
Venture Grant Phase II
Enhancement
Base Realignment
1. Timeline Extension Until
a. Attach revised timeline
b. If the budget is impacted, check and complete #2 below
c. Attach a one-page summary identifying new benchmarks or modified timing of benchmarks
2. Budget Modification
a. Attach revised budget
b. Attach revised budget narrative
c. Attach a one-page summary describing any impact to operations
3. Partner Change
a. Attach a one-page summary describing reason for the change and identifying new partner(s)
b. Attach the COE Verification of Private Sector Participation Form or other document describing matching
contribution(s) and the collaboration with the Center
4. Material Change to Scope of the Project
a. Consult with the Department of Commerce to determine what supporting material should be provided
b. Check and complete any of the above or below options if impacted by the change
5. Minor change to project altering the budget <20% (Research ND, Research ND BIO, and Venture grants only)
a. Provide documentation demonstrating approval by both RU and PSP
b. Check and complete any of the above or below options if impacted by the change
6. Other
a. Attach a one-page summary describing the change(s)
b. Consult with the Department of Commerce to determine what supporting material should be provided
Submission: Change Request Forms are to be submitted electronically to the North Dakota Department of Commerce
at researchND@nd.gov.
The Change Request Form is a formal request to approve the change(s) noted above to our initial request. I certify that
the information contained herein this request is accurate to my knowledge. I further certify that I am an authorized signor
for the institution making the change request.
Center Director/PI Signature
Printed Name
Date
University Authorized Representative Signature
Printed Name
Date
Research ND & Venture Grant Phase I, II & I/II Only
PSP Authorized Signature
Printed Name
Date
For Office Use Only
Date Received
Date of Commission Action
Commission Action
Date Copy Forwarded to Center
Approved
Not Approved
Other
Administrative Action
Signature
Date
Approved
Not Approved
Other