This form may be used for disclosures of potential Conflicts of Interest whenever they occur and throughout the year. PLEASE NOTE: Annual and Research Reporting disclosures are required separately from this form and occur as follows: 

  1. Annual Reporting takes place in the fall each year and is completed in MyInfo. 
  2. Research Reporting takes place internally within the Office of Sponsored Programs ePCF


* Required Fields

Personal Information

Disclosures - Please disclose any new conflicts of interest

  1. I, my spouse, and/or dependent child(ren) have the following interests or relationships:

  2. In my position at MSU, I have responsibility for decisions which may result in direct benefits or detriments to:

  3. I am an inventor of intellectual property developed at and owned by MSU. An outside entity wishes to license rights to this technology, and I participate (or plan to participate) at this company as a(n):

  4. I perform outside consulting activities that are directly related to my position or job duties at MSU:



The information contained in this form is complete and accurate to the best of my knowledge, and I acknowledge my continuing obligation to update my disclosure when there is a significant change in my personal or financial interests creating potential Conflicts of Interest. The Office of Research Compliance will determine if the conflict can be managed and institute a Conflict of Interest Management Plan if appropriate.