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.