New Conflict of Interest Disclosure Statement - Office of Research Compliance

I, my spouse, and/or dependents have the following interests or relationships:

Related Outside Interest. The acquisition of any personal or financial interest in an entity engaged in University commercial or research activities that may create a conflict of interest/conflict of commitment. This may include but is not limited to consulting arrangements, research activities, University contracts and agreements, or other business relationships.

Outside Professional or Commercial Commitments. Outside professional or commercial commitments, whether paid or unpaid, that interfere or have the potential to interfere with the employee’s University responsibilities. NOTE: This disclosure requirement does not include traditional academic responsibilities such as oral presentations, peer review, books and graphic works for publication, articles, for which royalties, honoraria, are considered a part of an employee’s University responsibilities.

Outside Academic Appointments. Visiting appointments during an approved leave of absence or brief transitional appointments.

Foreign Government or Entity Affiliations. Funding received from any foreign government or entity, any courtesy or honorary appointments that are held at other institutions and any participation with any foreign talent program.

Related Interest by Outside Position. The holding of an executive or officer position in or serving as a member of the board of directors of an entity engaged in University commercial or research activities.

Employee Inventor Equity Interest and/or Business Participation. Participation as an employee, officer, board member, or owner in an entity which has (or wishes to have) rights to intellectual property for which you were an inventor or creator in your work for MSU as provided in Board of Regents Policy 407. If you wish to participate on the outside with a company who licenses technology from MSU, the relevant campus office will facilitate your submission to request state approval.

Favoritism and Relationships in the Workplace. The planned direct participation in a University decision which would or could appear to involve a direct benefit or detriment to. A family member, partner, favoritism, and work unit as defined by the relevant campus Relationships in the Workplace Policy: These Include: A spouse, domestic partner, or fiancé(e); a child, grandchild, parent, grandparent, sibling, uncle or aunt, nephew or niece, cousin, or the spouse, domestic partner, or fiancé(e) of any such person; a person having a step-relationship; a parent-in-law or a brother- or sister-in-law; any other person who resides in the same household as the employee; or any other person as to whom it would reasonably appear the employee has a relationship involving an interest in such person comparable to the preceding.

Outside Supervisory Interest. Arrangements for the employment or use of students or employees outside the University.

None of the Above Apply.

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

A relative as defined in MSU's Nepotism Policy

A person in whom or with whom I have a financial interest

A person with whom I have a consensual romantic relationship

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):

Employee

Officer

Board Member

Owner

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

Yes

New Conflict of Interest/Conflict of Commitment Disclosure Statement

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New Conflict of Interest/Conflict of Commitment Disclosure Statement

ORC Director

ORC Assistant Director

IRB Administrator

Biosafety Officer

Radiation Safety Officer

Export Control

Jutila Research Manager/Laboratory Safety Specialist

COI Program Manager and Contract Specialist

Training and Development Coordinator

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