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Conflicts Interest (Nova Southeastern University)

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CONFLICTS OF INTEREST
DECLARATION & DISCLOSURE STATEMENT
Name:
________________________________
NSU ID:
_______________________________
I have read the University's Conflict of Interest - Declaration & Disclosure Policy and I agree to comply with its
provisions. I also affirm that my answer to the following question is true and correct to the best of my knowledge. I
understand that any intentional omission or misrepresentation of information on this form may result in disciplinary action
up to and including termination.
If the answer to this question is yes, describe below or on an attached sheet.
No
Yes
If yes, describe/explain here:
Signature
Date
INSTRUCTIONS FOR SUBMISSION: Complete, print and sign form. Forward completed form to the Office
of Human Resources located in the Horvitz Administration building on the main campus .
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Conflicts Interest (Nova Southeastern University)

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Completed 24 July 2020

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