CALS Conflict of Interest Disclosure Statement

 
 
 
 
 
 
 

 

Below are key areas in which the university requires disclosure of potential conflicts of interest. Please provide as much detail as possible for any applicable situations.

 

1 - List all relatives employed at Cornell with whom you also have a current or potential business relationship, specifically involving purchasing or receiving goods and services, creating revenue contracts, processing gift agreements, or directing and supervising work.

 

Name

Unit and Position

Explanation of how roles intersect

 
 

2 - Disclose independent contractors or businesses you have an outside relationship with if you will engage with them to conduct business on behalf of Cornell. For example, if you are responsible for sourcing trainers for programs you are overseeing and the person you are hiring is a relative, you need to disclose this relationship.

 

External Business or Vendor Name

Position

Explanation of How Roles Intersect

 
 

3 - Disclose and list additional employment and consulting work you or a family member perform which may conflict or intersect with your duties at Cornell.

 

Related Engagement or Business

Type of Outside or Additional Employment

Services Provided

Explanation of How Roles Intersect

 
 

4 - List any outside business or interest in a business you have that also sells or provides the types of equipment or services you are purchasing on behalf of Cornell.

 

Related Business or Business Interest

Related person at the Business

Type of Products or Service Being Purchased

Explanation of Potential Conflict

 
 

5 - List all board member positions in non-profit or professional associations which may have some type of connection to your work at Cornell. Please report all elected offices, appointed public offices, or paid governmental positions you hold regardless of whether you think they are related to your work at Cornell.

 

Board or Government Position

Is the position paid or unpaid?

Your role in the organization

Explanation of Potential Conflict

 
 

To the best of my knowledge, the above information is accurate and I have fully disclosed all potential conflicts of interest.