Conflict of Interest Disclosure Form

It is critically important that faculty or staff ("employees) of the University of New Haven (the 'University") avoid activities or relationships that may harm or damage the interests and reputation of the University and expose it to legal and financial risk. A conflict of interest exists when employees put their interests ahead of the University's interests for their own personal gain. Employees should not allow their own interests or that of an immediate family member or any other person to influence the decisions they make and the actions they take on behalf of the University.

Conflict of Interest
If, after reading the Conflict of Interest Policy, you believe you have any relationships, positions, activities, or commitments that could be a conflict of interest or contribute to a conflict of interest, then please explain and describe them below. External consulting activities should also be reported:
Date Date / MM / DD YYYY
Name Name First Last
Faculty

Faculty Faculty Administrative Staff
Title
Department
Email
Supervisor or Department Chair
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Draw or Type

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Full Name

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