Non-Research COI/COC & Potential Nepotism Disclosure Form
Prior to completing the Non-Research COI/COC & Potential Nepotism Disclosure Online Form, employees are advised to consult with their college or unit leadership to determine whether its use is appropriate. Certain colleges or units may have established their own disclosure forms or processes that better align with their operational needs. Employees should consult with their manager for specific guidance.
Note: This form is intended solely for the disclosure of actual, apparent, or potential non-research conflicts of interest or commitment. For any disclosures related to research, please contact the Office of Research Integrity and Assurance (ORIA). If there are no conflicts to disclose, completion of this form is not required.
Utilizing the online form allows employees to complete and submit their disclosures electronically.
Once submitted, the form will be routed sequentially to the employee’s assigned manager, local HR representative, and the Unit Head (or designee) for review.
The form routing system allows for receipt of email notifications to aid in tracking the decision-making process, including a link to a read only version of the form responses and the ability to check the status of the review.
Only the assigned manager, local HR representative and Unit Head (or designee) can open and review the submitted form. Once assigned to the designated reviewers, any updates to the reviewer role(s) for pending forms can be made by contacting hrpolicy@cornell.edu for manual reassignment.
Wondering if you need to fill out the form – would you answer 'yes' to any of these questions?
Did you or a family member receive or may receive (in your capacity as a Cornell employee) any gifts, favors, or other perks with a value of more than $75 from any non-Cornell individual or entity?
Do you have, or will you have, any managerial responsibilities (including self-employment) for any company or organization outside of Cornell?
Do you use or anticipate using Cornell facilities or equipment owned or operated by Cornell to support an external entity or activity (including consulting)?
Do you use or anticipate using Cornell students or staff over whom you exercise supervisory or academic responsibility to support an external entity or activity (including consulting)?
Do you have a family member or someone with whom you have a personal relationship (see Policy 6.14) in the same college, department, or unit as you? If so, could your role reasonably influence (or be seen as influencing) decisions about their job, academic progress (like admission, grading, or advising), fulfillment of administrative duties (such as approving budgets, purchasing, or resources), or create any other situation that might affect or appear to affect your ability to make impartial, unbiased decisions in your professional duties?
Are you in a position to initiate, participate in, or be responsible for making employment decisions related to a family member or an individual with whom you are involved in a personal relationship? Refer to Policy 6.14 for definitions of "family", "personal relationship", and "employment decisions" in considering your response.
Do you have a family member who holds a central unit transaction review or approval role for transactions for which you initiate, process, or have payment approval authority? Refer to Policy 4.14 for the definition of "family" in considering your response.
Do you or a family member hold an Equity Interest (e.g. stock, stock option, or other ownership interest, other than mutual or index funds) that exceeds 5% or a value of $5,000 in any entity that does business with Cornell?
Does a family member or other person or entity with whom you have a business associate relationship provide goods or services to Cornell or otherwise engage in business transactions with Cornell where you have influence in their selection process or transaction approval? Refer to Policy 4.14 for the definition of "family" and "associate" in considering your response.
Have you received more than $5,000 income from any single non-Cornell source during the calendar year or expect to do so in the next 12 months? (Includes salary, consulting fees, paid speaking engagements, expert witness testimony fees, honoraria, expense reimbursement, etc.)
Do you hold or plan to seek election or appointment to a public office during the next 12 months?
Are there any other situations that you may reasonably foresee as creating an actual or potential conflict of interest or commitment between your role at Cornell and an outside interest, activity, or relationship (including an actual or perceived ability to influence or derive personal benefit)?
