East Carolina University Faculty Manual
ECU POLICY ON CONFLICTS OF INTEREST AND COMMITMENT
Example Form D
REPORT OF POTENTIAL CONFLICTS OF INTEREST RELATED TO
TEACHING AND OWNERSHIP OF INTELLECTUAL PROPERTY
Provide the following information and discussion pertaining to Questions 9 or 10 answered with a YES on the Annual Faculty Report of Potential Conflict of Interest Activities or Relationships Form. If additional space is needed for listing multiple entities or information, attach separate pages labeled "REPORT OF POTENTIAL CONFLICTS OF INTEREST RELATED TO TEACHING AND OWNERSHIP OF INTELLECTUAL PROPERTY Continued" and noting the answer number for which additional information is provided.
________________________________ _______________ _______________ ________________
Employee Name Department College/School Reporting Period
If you answer YES to Question 9 on the Annual Faculty Report, provide the information requested by items 1-3. Here textbook refers to any textbook, course pack, lab manual, or other course material required for a class that you teach and is authored by you or a member of your immediate family.
1. Textbook title or nature of specific course material:
2. List the course (number and title) for which this textbook is required:
3. Describe the process used and the basis by which this textbook was chosen for this course instead of other comparable textbooks or materials.
If you answered YES to Question 10 on the Annual Faculty Report, provide the information requested in items 4-6.
4. Describe the intellectual property owned by you that is used by the University.
5. How is this intellectual property selected for use by the University?
6. Do you receive any compensation of any type whatsoever as a result of the use of such intellectual property by the University?
7. Does the University’s use of this intellectual property affect or potentially affect your objectivity as a University employee?
____YES ____NO. Why or why not?
If your answer is YES above, then explain what safeguards exist.
I certify that all of the above information is correct and that I will update this information promptly as changes occur.
Employee Signature: Date
Reviewed by: Approved by:
Department Chair Date Dean Date