East Carolina University Faculty Manual

APPENDIX I.

ECU POLICY ON CONFLICTS OF INTEREST AND COMMITMENT

Example Form E

 

NOTICE OF INTENT TO ENGAGE IN EXTERNAL PROFESSIONAL ACTIVITIES FOR PAY

 

Date ______________________

 

_____________________________________________ (name), a full-time employee, intends to engage in external professional activity for pay under the following conditions:

 

l. Name and address of contracting organization:

 

2. Nature of proposed activity:

 

3. Beginning date and anticipated duration of activity:

 

4. On average, how many hours per week will be devoted to this activity?

a.         For 12-month employees, for the anticipated duration of the activity, within the current fiscal year ending June 30:

 

b.         For 9-month employees, for each component part of the academic year, as applicable, within the current fiscal year ending June 30 (see Policy section 3.b.):

                        (1)       Second summer session (post July l) ________________

                        (2)       Fall semester ___________________________________

                        (3)       Spring semester _________________________________

                        (4)       First summer session (pre July 1) ____________________

 

 

5. Total number of hours to be devoted to activity:

 

6. Identify any classes, meetings or other University duties that will be missed because of involvement in the proposed activity (respond separately for each applicable component  part of the academic calendar if 9 month employee) and state what arrangements have been made to cover any such duties:

 

                          Duties Missed                            Arrangements to Cover

            ___________________________           ___________________________

            ___________________________           ___________________________

            ___________________________           ___________________________

 

7. Use of University resources in connection with proposed activity:

a.         Will the activity entail the use of any University resources (see discussion at section 2.e. of Policy - UNC General Administration Policy Statement on External Professional Activities of Faculty and Other Professional Staff (1993))?

                                    (  ) Yes (  ) No

 

            b.         If yes, describe what resources will be used.

 

8. To your knowledge, does the contracting organization above provide funding which directly supports any of your University duties or activities?                (  ) Yes (  ) No

 

9. To be completed if the contracting organization is a private firm:

a.         Do you or any member of your immediate family own an equity interest in the contracting organization?                         (  ) Yes (  ) No

 

            b.         Do you hold an office in the contracting organization?

                                    (  ) Yes (  ) No

 

10. Performance of the above described activity is consistent with the Board of Governors Policy on External Professional Activities.

 

 

Signature: ________________________________________

 

 

Department _______________________________________

 

 

Academic Rank or Job Title __________________________

 

Administrative Title (if any) ___________________________

 

 

ACTIVITY DURING PAST FISCAL YEAR

Provide the following information for each External Professional Activity for Pay in which you engaged during the last fiscal year preceding the date of filing of this “Notice of Intent”.

 

1.         Contracting organization:

2.         Beginning and ending date of activity (if complete):

3.         Average hours per week devoted to this activity:

4.         Total number of hours devoted to this activity:

5.         Nature of Professional Activity:

6.         Date Notice of Intent was filed:

 

 

ADMINISTRATIVE ACTION ON NOTICE OF INTENT

1. Reviewed activity determined to be consistent with University policy.

 

                                                                                                                                                                                   

                                     Date                                                               Department Head

 

Other action (as required):

 

                                                                                                                                                                                   

                                    Date                                                    Dean or Other Administrative Officer *

 

 

*Approval by dean or other administrative officer to whom department head reports is required if question 8 or question 9.a. or 9.b. is answered in the affirmative.

           

 

2. Reviewed activity determined not to be consistent with University policy.

 

                                                                                                                                                                                   

                                    Date                                                                Department Head

 

            Action on appeal (if any):

 

                                                                                                                                                                                   

                                    Date                                                                Action taken

 

                                                                                                                                                                                   

                                                                                                                        Dean or Other Administrative Officer

 

                                                                                                                                                                                   

                                    Date                                                                Action taken

 

                                                                                                                                                                                   

                                                                                                                        Chancellor

 

 

Any administrative action approving a “Notice of Intent” shall be effective only for the remaining balance of the fiscal year (in the case of 12-month employees) or for the balance of the academic year (for 9-month employees); see UNC General Administrative Policy Statement on External Professional Activities of Faculty and Other Professional Staff (1993) Section 3.b.