FINANCIAL CONFLICT of INTEREST SUBRECIPIENT CERTIFICATION of COMPLIANCE
National Science Foundation Funded Projects
Subrecipient Organization Information:
Legal Name:
Authorized Official: Email:
Title: Phone:
University of Northern Colorado Information:
Principal Investigator Name:
Project Sponsor:
Source of Funding:
Project Title:
Subrecipient Certification of Financial Conflict of Interest Compliance (check the appropriate response):
I certify to the following:
Subrecipient has implemented and is enforcing a written policy of financial conflict of interest
compliant with the National Science Foundation (NSF) provisions of Chapter IV, Part A of the
current Award and Administration Guide. All Subrecipient investigators (individuals responsible for
the design, conduct or reporting of the proposed project) have made the required disclosures in
accordance with that policy. Should the proposed project be funded, Subrecipient will provide
information related to any identified financial conflict of interest to the University of Northern
Colorado prior to the execution of a sub-award; or, in cases where a disclosure is made during the
course of the sub-award, within 45 days of receiving the Investigator’s disclosure.
Or:
Subrecipient has not implemented a written policy of financial conflict of interest compliant with
National Science Foundation (NSF) provisions of Chapter IV, Part A of the current Award and
Administration Guide. Subrecipient investigators (individuals responsible for the design, conduct or
reporting of the proposed project) involved on this project will follow the Financial Conflict of
Interest Policy of the University of Northern Colorado. Names of all Subrecipient investigators on the
proposed project are identified below, and a University of Northern Colorado Subrecipient
Disclosure of Significant Financial Interests Form has been completed and is attached for each
investigator.
Investigator Name
Position or Title
1.
2.
3.
4.
Signature of Subrecipient Authorized Official Date
The signed Compliance form with Investigator Disclosure forms should be faxed to
Sherry May at 970-351-1934 or emailed as attachments to sherry.may@unco.edu.
05.2016
Clear Form