This question applies to the Principal Investigator only: Do you, your spouse or domestic partner, or any of your dependent children have a
potential and/or real financial conflict of interest with the sponsor of this project, including all secondary sources? Yes No
If yes, a “Financial Conflict of Interest Detailed Disclosure Form” must be submitted to the FCOIC annually or when a change occurs.
The form and more information are available at: www.research.wayne.edu/coi. For additional information, contact the Conflict of Interest
Coordinator at 313-577-9064.
If “yes,” the FCOI committee communication must be included with the submission.
Endorsements and Financial Conflict of Interest Disclosure:
Objectivity in research is a key component of any research project. One method for maintaining objectivity is to have all individuals involved in
research design, development, or data evaluation/analysis disclose any potential and/or real financial conflict of interest.
Examples of relevant relationships for potential conflict of interest include but are not limited to:
(1) receiving past, current, or expecting future income in the form of salary, stock or stock options/warranties, equity, dividends, royalties, profit
sharing, capital gain, forbearance or forgiveness of a loan, interest in real or personal property, or involvement in a legal partnership with
(2) receiving past, current, or expecting future income in the form of consulting fees, honoraria, gifts, gifts to the University, or payments
resulting from seminars, lectures, or teaching engagements, or service on a non-federal advisory committee or review panel
(3) serving in a corporate or for-profit leadership position, such as executive officer, board member, fundraising officer, agent, member of a
scientific advisory board, member of a scientific review committee, or member of a data safety monitoring committee, regardless of
(4) inventor on a patent or copyright involving technology/processes/products licensed or expected to be licensed to the sponsor.
For students or individuals without a WSU faculty appointment, a WSU faculty supervisor/sponsor or authorized signatory (official from DMC, KCI, etc.) is required. The full
change in PI form must be completed. This document is only for signature documention.
the research, as approved by the IRB, and abide by the IRB’s policies and procedures. The PI change does not take effect until the
investigator has received documentation of IRB review and final approval.