or greater. Income includes your gross income and your
community property interest in your spouses or registered
domestic partner’s gross income totaling $500 or more.
Gross income is the total amount of income before deducting
expenses, losses, or taxes. (See Gov. Code Section 82030.)
What is a Loan?
Loans received or outstanding are reportable if they total
$500 or more from a single lender. Your community
property interest in loans received by your spouse or
registered domestic partner also must be reported. (See
Gov. Code Section 82030(a).)
What is a Gift?
A gift is anything of value for which you have not provided
equal or greater consideration to the donor. A gift is
reportable if its fair market value is $50 or more. In
addition, multiple gifts totaling $50 or more received from a
reportable source must be reported.
It is the acceptance of a gift, not the ultimate use to which
it is put, that imposes your reporting obligation. Therefore
you must report a gift even if you never used it or if you
gave it away to another person.
If the exact amount of a gift is not known, you must make a
good faith estimate of the item’s fair market value. Listing
the value of a gift as “over $50” or “value unknown” is not
adequate disclosure.
Commonly reportable gifts include:
• Tickets/passes to sporting or entertainment events
• Tickets/passes to amusement parks
• Parking passes
• Food, beverages, and accommodations, including that
provided in direct connection with your attendance at
a convention, conference, meeting, social event, meal,
or like gathering, where you did not give a speech,
participate in a panel or seminar, or provide a similar
service
• Rebates/discounts not made in the regular course of
business to members of the public without regard to
ofcialstatus
• Wedding gifts
• An honorarium. You may report an honorarium as
income rather than as a gift if you provided services of
equal or greater value than the payment received.
• Transportation and lodging
• Forgiveness of a loan received by you
(See Gov. Code Section 82028.)
FPPC Form 700-U (2009/2010)
FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov
Who Files Form 700-U?
ThisformmustbeledbyallpersonsemployedbyUCor
CSUwhohaveprincipalresponsibilityforaresearchproject
iftheprojectistobefundedorsupported,inwholeorin
part, by a contract or grant (or other funds earmarked by
thedonorforaspecicresearchprojectorforaspecic
researcher) from a nongovernmental entity.
Reporting requirements are outlined in Regulation 18755.
This regulation provides that research funding by certain
nonprotentitieswillnottriggerdisclosure.Thisregulationis
available on the FPPC website.
What is the Reporting Period?
For"initial"statements,beforethenalacceptanceofthe
contract,grant,orgift,thelermustreportinvestmentsin
and business positions with the sponsor as of the date that
the award is made, and income and gifts received from
the sponsor within the 12 months prior to the date that the
award is made.
For"interim"statements,thelermustsubmitastatement
within 30 days after the contract, grant, or gift is renewed
that discloses reportable investments, income and
businesspositionsthatthelerheldorreceivedduringthe
periodbetweenthedatetheinitialstatementwasledand
thedatetheprojectcontract,grant,orgiftwasrenewed.
What is an Investment?
“Investment”meansanynancialinterestinabusiness
entity in which you, your spouse or registered domestic
partner, or your dependent children have a direct, indirect,
orbenecialinteresttotaling$2,000ormore.Reportable
investments include stocks, bonds, warrants, and options,
including those held in margin or brokerage accounts and
investment funds. Common examples of investment funds
are index funds, exchange-traded funds, and venture capital
funds. (See Gov. Code Section 82034.)
What is Income?
Income means a payment received, including but not limited
to any salary, wage, advance, dividend, interest, rent, proceeds
from any sale, gift, including any gift of food or beverage, loan
forgivenessorpaymentofindebtednessreceivedbytheler,
reimbursement for expenses, per diem, or contribution to an
insurance or pension program paid by any person other than
an employer, and any community property interest in income
of a spouse or registered domestic partner. Income also
includes an outstanding loan. Income of an individual also
includes a pro rata share of any income of any business entity
or trust in which the individual, spouse, or registered domestic
partnerownsdirectly,indirectly,orbenecially,a10%interest
Instructions for Completing
Form 700-U
700-U
CALIFORNIA
FORM
A. Areyou adirector,ofcer,partner,trustee,consultant,
employee, or do you hold a position of management in
the entity listed in Part 1? No
Yes
Title:
Initial (for new funding)
Date of initial funding: / /
STATEMENT OF ECONOMIC INTERESTS
FOR
PRINCIPAL INVESTIGATORS
A Public Document
NAME (LAST) (FIRST) (MIDDLE)
ACADEMICUNITORDEPARTMENT MAILCODE
( )
TELEPHONENUMBER
FPPC Form 700-U (2009/2010)
FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov
Name of Entity:
Address of Entity:
PrincipalBusiness ofEntity:
Amount of Funding: $
Estimated
Actual
3. Filer Information
1. Information Regarding Funding Entity
(Usea separateForm 700-Ufor eachfunding entity.)
3. Filer Information - Cont.
E-MAIL ADDRESS
Date Received
Campus Use Only
Please type or print in ink.
700-U
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA
FORM
2. Type of Statement (Check at least one box)
Interim (for renewed funding)
Funding was renewed on: / /
E. Have you received gifts from the entity listed in Part 1
within the last 12 months valued at $50 or more?
No
Yes
describe below.
Description:
Value: $ Date Received: / /
D. Have you received loans from the entity in Part 1 for which
the balance exceeded $500 during the reporting period?
No
Yes
highest balance:
$500 - $1,000 $1,001 - $10,000
$10,001 - $100,000 Exceeded $100,000
If you checked “yes,” was the loan:
Secured Unsecured Interestrate: %
Was the loan entirely repaid within the last 12 months?
No Yes
Campus:
ID No:
B. Doyou, yourspouse orregistered domesticpartner,or
your dependent children have an investment of $2,000
or more in the entity listed in Part 1 above?
No
Yes
value is:
$2,000 - $10,000 $10,001 - $100,000
$100,001 - $1,000,000 Exceeds $1,000,000
Date Disposed:
/ / , if applicable
Description:
Amt: $ date(s): / / / /
(If applicable)
Type of Payment: (check one) Gift Income
F. Has the entity in Part 1 paid for your travel during the
reporting period
? No
Yes
describe below.
4. Verication
I have used all reasonable diligence in preparing this statement. I
have reviewed this statement and to the best of my knowledge the
information contained herein and in any attached schedules is true
andcomplete.Icertifyunderpenaltyofperjuryunderthelawsof
the State of California that the foregoing is true and correct.
Date Signed
(month, day, year)
Signature
(File the originally signed statement with your university.)
The Form 700-U is for university use only.
This statement is a public record under Gov. Code Section 81008(a).
TITLEOFRESEARCHPROJECT
C. Have you received income of $500 or more from the
entity listed in Part 1 during the reporting period?
No
Yes
amount is:
$500 - $1,000 $1,001 - $10,000
$10,001 - $100,000 Exceeds $100,000
Was this income received through your spouse or
registered domestic partner?
No Yes
Completion Statement, CSU Req. Project ended:
Clear Form
Print Form
• Food, beverages, and necessary accommodations
received directly in connection with an event held inside
or outside California at which you gave a speech,
participated in a panel, or provided a similar service
(note that payments for transportation outside of
California are reportable)
• Atravelpaymentwhich wasreceivedfromanonprot
entity exempt from taxation under IRS Code Section
501(c)(3) for which you provided equal or greater
consideration
Check the box to indicate if the payment was a gift or
income, report the amount, and disclose the date(s) if
applicable.
Violations
FailuretoletherequiredStatementofEconomicInterests
orfailuretoreportanancialinterestmaysubjecta
principalinvestigatortocivilliability,includingnes,as
wellasUniversitydiscipline.(Gov.CodeSections81000-
91014)
Privacy Information Notice
Information requested on all FPPC forms is used by the
FPPC to administer and enforce the Political Reform
Act (Gov. Code Sections 81000-91014 and Regulations
18109-18997). All information required by these forms is
mandated by the Political Reform Act. Failure to provide
all of the information required by the Act is a violation
subjecttoadministrative,criminalorcivilprosecution.All
reports and statements provided are public records open
for public inspection and reproduction.
If you have any questions regarding this Privacy Notice or
how to access your personal information, please contact
the FPPC at:
General Counsel
Fair Political Practices Commission
428JStreet,Suite620
Sacramento, CA 95814
(916)322-5660
What is a Travel Payment?
Travel payments include advances and reimbursements
for travel and related expenses, including lodging and
meals.
• Travel payments are gifts if you did not provide
services which were equal to or greater in value
than the payments received. You must disclose gifts
totaling $50 or more from a single source during
the period covered by the statement. Gifts of travel
are reportable without regard to where the donor is
located.
When reporting travel payments which are gifts, you
must provide a description of the gift and the date(s)
received.
Travel payments are income if you provided services
which were equal to or greater in value than the
payments received. You must disclose income
totaling $500 or more from a single source during the
periodcoveredby thestatement. The lerhasthe
burden of proving the payments are income rather
than gifts.
When reporting travel payments as income, you must
describe the services you provided in exchange for
the payment. You are not required to disclose the
date(s) for travel payments which are income.
Giftsoftravelmaybe subjecttoa $420giftlimit.In
addition, certain travel payments are reportable gifts, but
arenotsubjecttothe giftlimit. SeetheFPPCfactsheet
entitled “Limitations and Restrictions on Gifts, Honoraria,
Travel, and Loans,” which can be obtained from the
FPPC at www.fppc.ca.gov.
You are not required to disclose:
• Travel payments received from any state, local, or
federal government agency for which you provided
services equal or greater in value than the payments
received
• Travel payments received from your employer in the
normal course of your employment
• Payments or reimbursements for transportation within
California in connection with an event at which you
gave a speech, participated in a panel or seminar, or
performed a similar service
Instructions for Completing
Form 700-U (continued)
700-U
CALIFORNIA
FORM
FPPC Form 700-U (2009/2010)
FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov