ADMINISTRATION. 7. Current Contractor Grant# (If applicable) Agency # Fund # 8. Are outgoing sub agreements proposed on this project?

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1 PROPOSAL CERTIFICATION (PC) FORM PAGE 1 of 5 Due Date: 07/31/2011 PDS Doc.#: Start Date: 08/01/2010 Program Project ID: Agency Code: PDS Umbrella Doc.#: ADMINISTRATION 1. Principal Investigator NATALIE GOODWIN-FRANK Dept./Div Name # Proposal Title TEST 2 FOR NATALIE 3. Prime Sponsoring Agency DEPARTMENT OF ENERGY Solicitation # 3a. Subawarding Entity (if applicable) 4. Sponsor/Mentor (if applicable) 5. Department Contact Person Natalie Marie Goodwin-Frank Telephone # 314/ For retrieval call Telephone # A. Proposal Type: X TEST For Central Use Only: EH&S Export Controls B. Purpose: X Research OSRS-Contracts CCS C. Document: X New Other Other 7. Current Contractor Grant# (If applicable) Agency # Fund # 8. Are outgoing sub agreements proposed on this project? Yes X No 9. Is off-campus space used in this project? Yes X No 10. Data Sharing Plan: Does any one budget year equal or exceed $500k in direct costs? Yes X No If Yes, is primary sponsor NIH? Yes X No If Yes, Data Sharing Plan and/or update is required. See NIH Data Sharing Policy at: Initial Budget 08/01/2010 to 07/31/2011 Total Budget 08/01/2010 to 07/31/2014 Period Period Sponsor WU Cost Sharing Initial Budget Total Sponsor WU Cost Sharing Budget Total Direct Cost Direct Cost F&A Cost F&A Cost TOTAL COSTS TOTAL COSTS F&A Rate(s) Used 52; 26 F&A Rate(s) Used Rates same as year 1

2 PAGE 2 OF 5 FOR PDS DOC #109973, OSRS-DC, Ver. Date: 12/15/2012 Key Personnel GOODWIN-FRANK NATALIE GRANTS AND ACCOUNTS SPECIALIST Other Significant Contributors

3 PAGE 3 OF 5 FOR PDS DOC #109973, OSRS-DC, Ver. Date: 12/15/2012 PRINCIPAL INVESTIGATOR CERTIFICATIONS Assurances / Certifications (Check YES or NO for each item) LIVE VERTEBRATE ANIMALS Will this project involve the use of live vertebrate animals? YES NO ASC approval date ASC protocol # (Attach copy of approval behind PC form) -or- Pending (will submit or have submitted to ASC) HUMAN SUBJECTS 1. Does this project meet any of the definitions of human subjects research as defined in the Human Research Protection Office (HRPO) "Policy and Procedures"? (see Section II at: ) If you are unsure whether your project involves human subject research activities, please contact HRPO contact information is available on the HRPO website at Yes No 2. If answer to question 1 is YES, check one box. Approval pending (will submit or have submitted to HRPO) Approval already obtained (attach copy of approval behind PC form) A. Approval date: B. Approval # C. Review Type Full Board or Expedited or Exempt HUMAN EMBRYONIC STEM CELLS Will this project involve the use of human embryonic stem cells? YES NO Date approved by the WU Embryonic Stem Cell Review Committee: Approval # (Attach copy of approval behind PC form) ENVIRONMENT HEALTH & SAFETY 1. Will Radioactive Substances be used on this project? YES NO Date approved by Radiation Safety Committee: Approval # -or- Pending (will submit or have submitted to Rad. Safety) 2. Will Recombinant DNA be used on this project? YES NO Date approved by Biosafety Committee: Approval # -or- Pending (will submit or have submitted to Biosafety Com.)

4 PAGE 4 OF 5 FOR PDS DOC #109973, OSRS-DC, Ver. Date: 12/15/2012 EXPORT CONTROLS 1. Will any project know-how, information, equipment, software, materials or technology used or YES X NO developed in connection with this research have any potential military use or application; and/or has any project know-how, information, equipment, software, materials or technology been designated by the sponsor as export-controlled under the federal export control laws? [See International Traffic in Arms Regulations (ITAR), United States Munitions List, 22 CFR Section 121.1, Export Administration Regulations (EAR), Commerce Control List, 15 CFR Section 774, Supp. 1, 2. Will the project involve any restrictions on your ability to publish the results of your research; YES X NO and/or will the project involve any restrictions on the participation of non-u.s. citizens in the research? 3. Will any foreign nationals (faculty, students, etc.) or foreign collaborators (investigators, YES X NO institutions, agencies, etc.) be involved on the project and/or have access to project know-how, information, equipment, software, materials or technology? Violations of the export control laws carry substantial civil and criminal penalties. If you have answered yes to all three of the questions above, please contact the University's Export Control Officer (collinsn@wustl.edu) prior to commencing work on the project in order to ensure compliance with the export control laws. NIH Public Access Policy Statement If this project has been or will be funded in whole or in part with NIH funds, complete the following: Your signature on this document signifies that all manuscripts resulting from use of NIH funds provided under this project and accepted for publication after April 7, 2008 have been or will be published in PubMed within 12 months of publication and, all publications listed in any grant progress reports list the PMCID reference number from PubMed as required, applicable and in accordance with NIH requirements. X Yes, this statement is true and correct. This requirement is not applicable for this project. For additional information, please refer to the following: Vice Chancellor for Research: Bernard Becker Medical Library: Please contact your Dept Administrator or assigned Grant Analyst if additional information is needed.

5 PAGE 5 OF 5 FOR PDS DOC #109973, OSRS-DC, Ver. Date: 12/15/2012 Principal Investigator Certifications and Signatures I certify, as Principal Investigator/Project Director, all persons independently responsible for the design, conduct, or reporting of the research on this project, as indicated below, have an up-to-date financial disclosure statement, as required by the sponsoring agency; and I understand failure of any individual, involved in the design, conduct, or reporting of the research, from maintaining the necessary disclosures during the period of award and/or complying with the Research Conflicts of Interest Policy and corresponding procedures will result in a review for non-compliance and, when applicable, sanctions for non-compliance. For more information, visit: Goodwin-Frank Natalie Grants and Accounts Specialist As Principal Investigator for this project, I certify that the information submitted within this application is true, complete and accurate to the best of my knowledge. I understand that any false, fictitious, or fraudulent statements or claims on this form or in the application may subject me to criminal, civil, or administrative penalties. If this proposal is funded, I agree to accept responsibility for the scientific conduct of the project, to conduct the project in accordance with the terms and conditions of the sponsoring agency, the policies of the University and Federal, State and local laws and regulations. I agree to provide all required progress reports to the sponsor in a timely manner. Signature of Principal Investigator Date APPROVALS Division Department Other Name Date Name Date Dean Name Date Name Date

University of Louisiana System

Policy Number: M-(16) University of Louisiana System Title: EXPORT CONTROL Effective Date: October 26, 2009 Cancellation: None Chapter: Miscellaneous Policy and Procedures Memorandum The University of