EGMS Forms Preparation  
REPA - A report of external professional activities Cancel and delete this REPA Form
 
 
 
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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
 
 
 
 
 
  For this and all subsequent REPA data entry screens, "you" refers to the person whose activities are being reported.

If you answer "Yes" to any of the questions on this screen, EGMS will provide additional screens for the purpose of gathering details on the external professional activities. If you answer "No" to all the questions on this screen, EGMS will provide a concluding screen for submitting the REPA form.


Question 1 asks about previous activities. Answer Question 1 for any external professional activities engaged in during the REPA reporting period 09/01/03-08/31/04.

1: Regardless of compensation, did you provide professional services that were related to your University activities to at least one outside organization, where the total time of service to a single organization exceeded three days over the course of the REPA reporting period?
 
          Yes                  No
 
 
What activities do and do not need to be reported?
 
What does "professional services" mean?

Questions 2, 3, and 4 ask about both previous interests and interests during the next 12 months. Answer these questions for any financial or 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.

2: Did, or will you, a member of your immediate family, or an associated entity (e.g. a trust) have a financial interest from or in a business that relates to your University activities and equals or exceeds either:
 
 
arrow right income of $10,000 from that business per year (including but not limited to royalties, consulting fees, and/or dividends), or

 
arrow right an equity interest in that business valued at $10,000 or representing 5% ownership (regardless of worth)?

          Yes                  No
 
 
What do "business" and "financial interest" mean?
 
What financial interests do and do not have to be disclosed?
 
What if I'm not sure about financial or business interests for the next 12 months?

3: Did, or will you, a member of your immediate family, or an associated entity (e.g. a trust), regardless of compensation, serve on a board of directors or advisory board for a business that supports (through gifts or sponsored support) your University research?
 
          Yes                  No

4: Did, or will you, a member of your immediate family, or an associated entity (e.g. a trust), regardless of compensation, hold an executive position in a business that engages in commercial or research activities that relate to your University activities?
 
          Yes                  No
 
 
What does an "executive position" mean?