Fillable Conflict Of Interest Declaration Form CBS Conflict of Interest Declaration Form

Fill Online, Printable, Fillable, Blank Conflict Of Interest Declaration Form CBS Conflict of Interest Declaration Form Form

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Conflict Of Interest Declaration Form CBS Conflict of Interest Declaration Form

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CBS CONFLICT OF INTEREST DISCLOSURE STATEMENT
This disclosure must be made for all academic and employment conflicts in existence in CBS and
presented to the Dean for a management plan in advance of an appointment or as soon as an apparent
conflict arises.
EMPLOYER / LAB
(name of faculty/staff holding the
conflict)
AFFECTED PARTY
(name of staff/student with whom
the conflict exists)
NATURE OF THE RELATIONSHIP
RATIONALE FOR APPOINTMENT
(why is this person the right one for
the appointment, despite the
conflict)
SUGGESTED MITIGATION
OPTIONS
Appointment Approved:
☐ Yes ☐ No
Dean’s Comments and Mitigation Plan:
Dean: Jonathan A. Newman
Date
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Conflict Of Interest Declaration Form CBS Conflict of Interest Declaration Form

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Completed 14 November 2019

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