Outside Employment/Income, Conflict of Interest, and Conflict of Commitment Disclosure Form

Employee Name

Banner ID

Conflict of Interest (COI) Committee Action (for committee use only)

Mark appropriate box ACCEPT/APPROVE MANAGEMENT PLAN
CONDITIONAL APPROVAL OF MANAGEMENT PLAN (Must include Recommendations listed below)
REJECT MANAGEMENT PLAN

Recommendations / Explanations

(Maximum characters: 775)
You have characters left.

Chairman of COI Committee Signature and Date lines

FINAL APPROVAL by Vice President/President responsible for unit:

(Employee and Immediate Supervisor must receive copies of final disclosure document with management plan.)

Division

Vice President/President Signature and Date lines

Approval of outside employment by University President (when required)

President Signature and Date lines