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Tribal Research Coordination Request
Tribal Research Coordination Request
Researcher First Name
Researcher Last Name
Are you an Indigenous Researcher?
Yes
No
What can the University do to help reduce the barriers for indigenous
researchers to submitting proposals and building research programs?
Researcher Email
Project Title
Description of Project
Project documents
Will the project involve IRB approval?
Yes
No
Is this request for consultation re: Tribal engagement related to a planned or specific
proposal/sponsored project?
Yes
No
Document Summary Sheet (DSS) number (if known):
Principal Investigator Name (if different from above)
Project/Sponsor Funder
Please select...
Environmental Protection Agency (EPA)
National Institutes of Health (NIH)
National Park Service (NPS)
National Science Foundation (NSF)
U.S. Department of Energy (DOE)
U.S. Geological Survey (USGS)
Other – Federal Agency
Other – Non-Federal Agency
Please identify
Please identify
Are you seeking any of the following
Securing a formal letter of support (or similar) from a Tribal Nation
Guidance on developing a written request to the relevant Tribe(s) to carry out proposed activity/activities that may require approval from the Tribal Nation(s)
Written confirmation from the Tribal Nation(s) that review and approval is not required
Written approval to carry out the proposed activities from an authorized designee of the Tribal Nation
Other
Please detail
Please attach a written request that
includes a summary of the project and details why
you believe review and approval is not required. Be
sure to include a place for concurrence/signature.
Please attach a written request that
includes a summary of the project and outlines
funding being committed in the proposal budget for
Indigenous partners. If no funding is being
committed in the proposal budget for Indigenous
partners, please explain why in your request. Be sure
to include a place for concurrence/signature.
Please describe
Announcement/Opportunity number or URL
Submission Deadline
Will funds be budgeted to support the work of indigenous partners?
Yes
No
Please explain
Part I
Does the Proposal include any of the following activities? (Check all that apply.)
Interior alterations/renovations
Theoretical and/or laboratory research
Data analysis/Modeling
Planning/conducting scientific workshops/conferences
Conduction day-to-day management activities of federally funded research and development centers
Field work not affecting the environment
Acquisition, installation, and/or operation of scientific instrumentation not affecting the environment
Field work affecting the environment
Drilling of the earth, excavation and/or use of explosives
Weather modification
Use of techniques that may alter or cause a major disturbance to the local environment
The release of biological-control agents
Construction (other than interior alterations)
Transition of technology from the development stage to large-scale commercialization
Part II:
Are any of the following associate with this Proposal?*
Yes
No
Unknown
Potential impacts (including direct, indirect, and/or cumulative impacts)
on sensitive biological resources (aquatic, marine, or terrestrial) or their habitat
Potential impacts (including direct, indirect, and/or cumulative impacts)
on historic, cultural, or archaeological resources
Potential impacts (including direct, indirect, and/or cumulative impacts)
on costal uses or resources
Potential impacts (including direct, indirect, and/or cumulative impacts)
on air quality (e.g., emissions that could affect local air quality or generate greenhouse gas emissions)
Potential impacts (including direct, indirect, and/or cumulative impacts)
on soils or geological/topographical features
Potential impacts (including direct, indirect, and/or cumulative impacts)
on water quality or quantity/streamflow characteristics (including impacts to wetlands or floodplains)
Potential impacts (including direct, indirect, and/or cumulative impacts)
on socioeconomic interests (i.e., on the local economy, schools, employment, housing, etc.)
Potential impacts (including direct, indirect, and/or cumulative impacts)
on existing land use
Potential impacts (including direct, indirect, and/or cumulative impacts)
on existing infrastructure
Potential impacts (including direct, indirect, and/or cumulative impacts)
on existing viewsheds or other visual resources
Potential impacts (including direct, indirect, and/or cumulative impacts)
on existing noise levels
Potential impacts (including direct, indirect, and/or cumulative impacts)
on minority or low income populations
Potential impacts (including direct, indirect, and/or cumulative impacts)
that increase environment and/or safety risks to children
Potential impacts (including direct, indirect, and/or cumulative impacts)
that result from the production of hazardous/solid waste or use of hazardous material
An activity or activities proposed to take place on lands or waters in which Native Americans, Alaskan Natives, or Native Hawaiians have an interest or connection
An activity or activities proposed to take place on lands or waters managed by a local, state, general, or foreign government entity (i.e., a park, forest, refuge, marine sanctuary, preserve, etc.)
An activity or activities that may have effects on the quality of the human environment that are likely to be highly controversial
*Please attach any supporting documents (i.e., maps/drawings, correspondence, mitigation measures, notes, etc.)
Part III
Which of the following are involved and/or impacted (or would be involved and/or impacted) in your Proposal
Tribal Nations
Confederated Tribes of Goshute
Paiute Indian Tribe of Utah
San Juan Southern Paiute Tribe
Northwestern Band of Shoshone Nation
Skull Valley Band of Goshute
Ute Indian Tribe of the Uintah and Ouray Reservation
Ute Mountain Ute Tribe
White Mesa Community
Navajo Nation
Confederated Tribes of Goshute additional information
Please explain the level of engagement requested
Do you
have an existing established relationship, or have you previously taken any
steps to build a relationship?”
Yes
No
Please explain
Paiute Indian Tribe of Utah additional information
Please explain the level of engagement requested
Do you
have an existing established relationship, or have you previously taken any
steps to build a relationship?”
Yes
No
Please explain
San Juan Southern Paiute Tribe additional information
Please explain the level of engagement requested
Do you
have an existing established relationship, or have you previously taken any
steps to build a relationship?”
Yes
No
Please explain
Northwestern Band of Shoshone Nation additional information
Please explain the level of engagement requested
Do you
have an existing established relationship, or have you previously taken any
steps to build a relationship?”
Yes
No
Please explain
Skull Valley Band of Goshute additional information
Please explain the level of engagement requested
Do you
have an existing established relationship, or have you previously taken any
steps to build a relationship?”
Yes
No
Please explain
Ute Indian Tribe of the Uintah and Ouray
Reservation additional information
Please explain the level of engagement requested
Do you
have an existing established relationship, or have you previously taken any
steps to build a relationship?”
Yes
No
Please explain
Ute Mountain Ute Tribe additional information
Please explain the level of engagement requested
Do you
have an existing established relationship, or have you previously taken any
steps to build a relationship?”
Yes
No
Please explain
White Mesa Community additional information
Please explain the level of engagement requested
Do you
have an existing established relationship, or have you previously taken any
steps to build a relationship?”
Yes
No
Please explain
Navajo Nation additional information
Please explain the level of engagement requested
Do you
have an existing established relationship, or have you previously taken any
steps to build a relationship?”
Yes
No
Please explain
Entities Involved
An organization or non-profit serving Indigenous partners
Individual Indigenous partners
Individual Indigenous members
Tribal Governments
Other
An organization or non-profit serving
Indigenous partners additional information
Please explain the level of engagement requested
Do you
have an existing established relationship, or have you previously taken any
steps to build a relationship?”
Yes
No
Please explain
Individual Indigenous partners additional information
Please explain the level of engagement requested
Do you
have an existing established relationship, or have you previously taken any
steps to build a relationship?”
Yes
No
Please explain
Individual Indigenous members additional information
Please explain the level of engagement requested
Do you
have an existing established relationship, or have you previously taken any
steps to build a relationship?”
Yes
No
Please explain
Tribal Governments additional information
Please explain the level of engagement requested
Do you
have an existing established relationship, or have you previously taken any
steps to build a relationship?”
Yes
No
Please explain
Other additional information
Please explain the level of engagement requested
Do you
have an existing established relationship, or have you previously taken any
steps to build a relationship?”
Yes
No
Please explain
Contact Information
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Last Updated: 8/1/24
