Attachment C-Conflict of Interest Form- Sample.pdf
PDF 31 KB Posted
- Attached to
- Team Nutrition Training Grant for Innovative State Training Programs Federal grant opportunity
- Opportunity number
- USDA-FNS-FY19-INNOV
- Issued by
- Department of Agriculture
About this file
Attachment C- Conflict of Interest Form-Sample
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| Transcript FY 2019 TNTG St Innov RFA Webinar (4-2-19) posted 5-2-19 .pdf | ||
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| _RFA - Team Nutrition Training Grant for Innovative State Training Programs.pdf | ||
| Attachment G- Letter of Intent.pdf | ||
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| Attachment E-Cover Page.pdf | ||
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Text version
Attachment C- Sample Conflict of Interest Form
FY 2019 Team Nutrition Training Grant for Innovative State Training Programs
Sample Conflict of Interest Form
A conflict of interest exists when there is evidence of or the appearance that an individual’s personal/professional interests or experiences have or may influenced situations or operations. And, that these interests take precedence over the interests, goals, and/or mission of the grant.
The Team Nutrition Training Grant for Innovative State Training Programs, Project Director is responsible for knowing what conflicts might exist and to manage, reduce, or eliminate those conflicts. The key to handling these potential conflicts is full disclosure of any potential conflict or the appearance of a conflict.
Each Social Scientist involved with the Innovative State Training Program grant must complete a conflict of interest disclosure form to inform Project Director of situations that pose or may give the appearance of conflict of interest.
If you have questions as to whether a conflict of interest exists, please discuss the situation with the Team Nutrition Training Grant for Innovative State Training Programs Project Director and/or disclose this information on the form.
I certify by signing below I acknowledge receipt of the Conflict of Interest Policy and that I have accurately completed this disclosure form to the best of my knowledge.
Please check the statement that pertains to your disclosure:
I hereby report that to the best of my knowledge, information and belief, no situation in which I am involved personally or professionally could be construed as a Conflict of Interest, or as placing me in a position of having a conflict of interest.
I hereby disclose the following circumstances that may constitute a conflict of interest, as described Conflict of Interest Policy above (please document all situations below that are or may be considered a conflict of interest)*:
* I understand that it is my responsibility to contact the Project Director with any changes that may occur throughout the period of performance of the Innovative State Training Program grant.
Social Scientist Name (please print) Social Scientist Signature
Role Date
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