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Forms and Templates

 

Significant Financial Interest (SFI) Disclosure form

Page One to be completed when submitting a proposal to SPA.  If funded, both pages to be completed and a signature obtained before funding can be released.  This form also needs to be submitted annually (by January 31) during the funding period.

Conflict of Interest (COI) Disclosure - Administrative Review Form

This form to be completed if you have indicated COI on your PTF.  You may have a conflict if you plan on working with, or entering into a financial transaction with your spouse, domestic partner, child, parent, sibling or in-laws, or if you have an economic interest in, or act as an officer or director of any outside entity.  If it is determined that a conflict does exist a COI management plan will need to be developed and approved, no funding will be released until the COI management plan has been approved.

You must obtain signatures from your Administrative Chair/Head, Dean, VPR and the Provost.

COI Management plan - Spouses template

This template may be used if your only conflict is a spousal conflict.

Your COI management committee must have at least three members (active, full-time faculty) with at least one member from outside your department.  The members must not have a working relationship with you and cannot be your Chair/Head or Dean.  One of the members will be the Chair of your COI management committee and the COI management plan will need to be reviewed annually, if the spousal relationship changes, and/or whenever new funding is acquired.  Please note the signatures required for approval.

COI Management plan template

Your COI management committee must have at least three members (active, full-time faculty) with at least one member from outside your department.  The members must not have a working relationship with you and cannot be your Chair/Head or Dean.  One of the members will be the Chair of your COI management committee and the COI management plan will need to be reviewed annually and/or whenever new funding is acquired.  Please note the signatures for approval.

Letter to student - Spouse COI template

Template if the spouse relationship is your only conflict.

Letter to student - COI template

Disclosure on papers/presentations template(s)


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RCA
Phone: 701.231.8045
Physical/delivery address:  1735 NDSU Research Park Drive/Fargo, ND 58102
Mailing address:  P.O. Box 6050—Dept. 4000/Fargo, ND 58108-6050
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Last Updated: Wednesday, May 10, 2017 4:41:02 PM
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