COI Approval Representations and Certifications

By clicking Approve on the online routing screen within the COI System, the individual to whom the Unity id and password is connected is making the following relevant certifications. Where that Unity id and password are not that of the employee department head, center director and dean or vice chancellor, then the Unity id that is recorded as having approved the proposal is the same as if it received the required personal review and personal approval of the employee, department head, center director and dean or vice chancellor. Delegation of COI approval authority is not allowed other than where pre-approved by the office of Research Administration. Understand clearly that making false representations about or providing false information in this application and its supporting documents is a specific violation of employment responsibilities which can result in disciplinary action and may be a criminal offense (U. S. Code, Title 18, Section 1001).

Note: If you object to any of these representations and certifications by making a note in any of the comments fields within the COI System; any such noted objections become null and void once you click “approve”. Should you have any questions or concerns about these representations and certifications, contact Jeffrey Cheek, Associate Vice Chancellor for Research Administration by phone at 515-2444 or e-mail at jeff_cheek@ncsu.edu.

Employee:

Original Certifications and Representations dated 07/01/2005

  1. I have read and understand the Conflicts of Interest and Conflicts of Commitment regulation outlined in PRR 01.25.01 posted at http://policies.ncsu.edu/regulation/reg-01-25-01 and I will comply fully with the objectives of that regulation.
  2. I certify that this conflict of interest form is complete and that to the extent one exists, it accurately portrays all potential conflicts of interest as required by the aforementionedregulation.
  3. Where applicable, I certify that the management plan I have outlined in the online COI system was discussed with appropriate leadership to whom I report and that we concur that it satisfactorily ensures my objectivity in conducting my duties as an employee of North Carolina State University.
  4. To the extent circumstances change wherein a potential conflict did not exist but comes to exist in the future, I will promptly (within 30 days of discovery) complete a modified conflict of interest disclosure via the COI System.
  5. By clicking “approve” on the approval screen within COI System I am stating that under penalty of perjury, I am making these certifications and representations personally and have not shared my access credentials with anyone else as is prohibited according to NC State University fundamental covenants on administrative computer system access outlined in the following URL: http://oit.ncsu.edu/rr-it-use/summary-and-guidance#section2

End Original Certifications and Representations dated 07/01/2005


For Department Heads, Center Directors, Vice Chancellors and Deans:

Original Certifications and Representations dated 07/01/2005

  1. I have reviewed this conflict of interest form for completeness and find that it has been satisfactorily completed. I represent that the form is accurate to the best of my knowledge, which is based on what the completing employee has disclosed herein.
  2. Where applicable, I certify that I discussed and collaborated in developing the management plan filed by the disclosing employee in the online COI System and that I will ensure compliance with that management plan to the best of my abilities.
  3. By clicking “approve” on the approval screen within the COI System I am stating that under penalty of perjury, I am making these certifications and representations personally and have not shared my access credentials with anyone else as is prohibited according to NC State University fundamental covenants on administrative computer system access outlined in the following URL: http://oit.ncsu.edu/rr-it-use/summary-and-guidance#section2

End Original Certifications and Representations dated 07/01/2005