East
Carolina University Faculty Manual
APPENDIX
I.
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.
SIGNATURES:
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