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Summary:
REPA For:
Bianco
Year and Period:
2004-09/01/03-08/31/04
Departmental Approver:
Brandt,Barbara F
Collegiate Approver:
Bock,Terry L

 
Help Options
REPA Guidelines
 
Code of Conduct
 
Outside Consulting, Service Activities, and Other Work
 
Conflict of Interest
 
EGMS Technical Helpline - (612) 624-1600
EGMS Business Helpline - (612) 624-1033
Email comments
      repa@egms.umn.edu
 
 
 
 
 
  An earlier answer indicated that, during the REPA reporting period 09/01/03-08/31/04 or the next 12 months, you, a member of your immediate family, or an associated entity (e.g., a trust) had or expect to have:



arrow right A financial interest from or in a business that relates to your University activities and that equals or exceeds either: income of $10,000 or equity interest valued at $10,000 or representing 5% ownership.

arrow right A board position at a business that supports your University research.

arrow right An executive position in a business that engages in commercial or research activities that relate to your University activities.


Answer the following questions as they relate to financial and business interests engaged in during the REPA reporting period 09/01/03-08/31/04 or expected to be engaged in during the next 12 months, as identifed above.
 
What financial and business interests do and do not need to be reported?
 
How should I answer these questions if I am filing this REPA for Patents, Technology, and Marketing purposes?

Royalties
  1:Have you received or will you receive, or be entitled to receive, royalties from the University or from another academic institution's royalty-sharing policy?
 
To which royalties does this question refer?
 
 

  Yes
  NoSkip to the next question
For instances where the above answer is Yes, did you or will you:

arrow right a) Assign students, postdoctoral fellows, or other trainees to research projects related to activities for which you have received, will receive, or will be entitled to receive royalties?
        Yes                  No

arrow right b) Participate in funded or unfunded research on a technology, process or product development related to the activities for which you have received, will receive, or will be entitled to receive royalties?
        Yes                  No


Financial Interests
 
What do "business" and "financial interest" mean?
 
What if I'm not sure about financial interests for the next 12 months?
 
  2: Regarding the previous or expected financial interest from or in a business that relates to your University activities, does that business provide funds (gifts or sponsored support) for your University research?
 
 

  Yes
  NoSkip to the next question
For instances where the above answer is Yes, did you or will you:

arrow right a) Assign students, postdoctoral fellows, or other trainees to projects supported by those funds?
        Yes                  No

arrow right b) Participate in research using those funds?
        Yes                  No



3: Regarding the previous or expected financial interest from or in a business that relates to your University activities, was or will that interest be of a nature other than consulting income and/or publishing royalties?
 
 
Note: Answer No if your financial interest is limited to consulting income and/or publishing royalties, and there is no other relationship between the business(es) for which you consult or from which you receive royalties and your University work.
To which royalties does this question refer?

 
 

  Yes
  NoSkip to the disclosure section
For instances where the above answer is Yes, did you or will you:
arrow right a) Assign students, postdoctoral fellows, or other trainees to instructional projects related to that business?
        Yes                  No

arrow right b) Participate in clinical trials or evaluation or development of a technology, process, or product owned or controlled by that business?
        Yes                  No

arrow right c) Make professional referrals to that business while acting in the context of your University duties?
        Yes                  No

arrow right d) Take administrative action on behalf of the University with respect to any University-affiliated organization that is related to that business?
        Yes                  No

arrow right e) Take administrative action on behalf of the University with respect to any supported research activity that is related to that business?
        Yes                  No



The above questions that you just answered were related to financial interests. An earlier answer indicated that you (or a member of your immediate family or an associated entity) also had or expect to have business interests.

Note: When providing supplemental disclosure information in the box below, remember to include information about financial and business interests.

Supplemental Information
  For each earlier Yes answer, as identified above:
 
 
arrow right Identify the entities in which you previously had or expect to have a financial or business interest;

 
arrow right Describe the nature of your previous interests or expected interests (e.g., royalties, equity interest, consulting income, executive position, member of the board of directors or advisory board);

 
arrow right Explain the relationship between your previous interests or expected interests and your University responsibilities;

 
arrow right Describe any previous involvement or expected involvement by students, and whether you serve as their primary advisor; and

 
arrow right Explain the mechanisms that have been or will be instituted to minimize the chances of conflict of interest occurring.

 
Supplemental information   (limit 1950 characters)
 
 



Relationships between Financial or Business Interests and Sponsored Projects
  Are any of your previous or expected financial or business interests related to your sponsored projects?
          Yes                  No
 
  If Yes, please list the sponsored projects below. List only those projects that relate to financial or business interests disclosed in this REPA.

Sponsored project details

  Identify the financial or business interest to which this sponsored project is related.



  Project Title


Funding Source


Principal Investigator


Project Dates  (mm/dd/yy format)
to

Annual Support $


Sponsored project details
  Identify the financial or business interest to which this sponsored project is related.



  Project Title


Funding Source


Principal Investigator


Project Dates  (mm/dd/yy format)
to

Annual Support $



  To detail more than one sponsored project, click Next Sponsored Project to add another data entry table.
 
 
Next sponsored project