Part III: Financial Interests (to be completed only if General Question 2 was answered "Yes") | >
Answer the following questions as they relate
to financial interests engaged in during the REPA reporting period or
expected to be engaged in during the next 12 months. |
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? |
| Yes
No | |
|
For instances where the above answer is Yes, did you or will you:
|
| 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 |
| 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
|
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
No | |
|
For instances where the above answer is Yes, did you or will you:
|
| a) | Assign students, postdoctoral fellows, or other trainees to projects supported by those funds? |
| | Yes
No |
| 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?
|
| Yes
No | 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.
|
|
For instances where the above answer is Yes, did you or will you:
|
| a) | Assign students, postdoctoral fellows, or other trainees to instructional projects related to that business? |
| | Yes
No |
| b) |
Participate in clinical trials or evaluation or development of a
technology, process, or product owned or controlled by that business? |
| | Yes
No |
| c) | Make professional referrals to that business while acting in the context of your University duties?
|
| | Yes
No |
| d) |
Take administrative action on behalf of the University with respect to
any University-affiliated organization that is related to that business? |
| | Yes
No |
| e) |
Take administrative action on behalf of the University with respect to
any supported research activity that is related to that business? |
| | Yes
No |