You must fill out a separate form for each company in which you have a financial interest and update each form annually or as changes occur.
This form is to be completed in connection with the Florida Gulf Coast University’s Policy on Financial Conflict of Interest in Sponsored Research, 2.018 by all key personnel who are involved in the review, design, analysis, conduct and/or reporting of research in which an entity of Florida Gulf Coast University is engaged. Answers should be completed based on the 12 months prior to form completion.
Should you have questions about the form, you may contact: Research@fgcu.edu.
Florida Gulf Coast University’s Office of Research & Graduate Studies will protect the confidentiality of private investments and personal finances and will request information related only to financial relationships that might influence the objectivity of research being conducted.
Your answer(s) to the questions do not imply that any financial interest you disclose is improper or impermissible. However, failure to report a financial interest or furnishing false, misleading or incomplete information may constitute professional misconduct and could be cause for disciplinary action.
In relation to the Entity above, please note the following section on Financially Interested Company: Significant Financial Interest: FGCU Policy Regarding Conflict of Interest requires that you report any compensation that you receive or Equity or Proprietary Interests that you have in an entity (i.e. the manufacturer of a product that is the subject of your Research project(s), its agent, or a company that is a direct and primary competitor to the manufacturer of the product) even if you purchased the Equity interest. The policy also requires that you disclose whether you hold a fiduciary position with an entity even if the position is unpaid.
Once you submit this form, you may NOT go back to make changes. You can use the Save and Resume Later link below to make changes prior to submitting to the form.
Note: Attachments will only be saved upon final submission of the form.