Reporting and Disclosure Forms

All investigators are required to disclose their outside financial interests to Brandeis on an annual and on an ad hoc basis.

Annual disclosures must be submitted no later than Oct. 1 for the previous fiscal year on an annual basis. At Brandeis, the fiscal year is July 1 to June 30.

Ad hoc disclosures must be submitted within 30 days of the initial appointment, employment or incident. These disclosures will occur throughout the fiscal year, as necessary.

All investigators must disclose reimbursable or sponsored travel related to their institutional responsibilities, as defined in the definition of financial interest.

Such disclosures must include, at a minimum, the purpose of the trip, the identity of the sponsor/organizer, the destination, the duration, and, if known, the monetary value.

Brandeis will not submit a research proposal unless the investigator(s) have submitted up-to-date disclosures (both ad hoc and annual).

Significant Financial Interests Report Form
Use this form to submit your Annual Disclosure and any Ad hoc Disclosure(s), as necessary. If you answered yes to any question, 1-4, you must also complete the Financial Interests Disclosure for each occurrence of a Financial Interest.

Financial Interests Disclosure Form
Use this form to submit a description of EACH OCCURRENCE of a financial conflict of interest. You may need to complete more than one form.

Expand All / Collapse All


Important

Please note
No handwritten forms will be accepted. To submit your Disclosure, print out these forms, sign them, and SCAN THEM into ONE pdf. Email the entire Disclosure to the Institutional Official at fcoi@lists.brandeis.edu.

Do not simply hit the "save" button in Adobe Acrobat or the information you entered on these forms will vanish.

If you would like to save the information and insert your electronic signature select File -> Print -> select "Adobe pdf" from the printer dropdown menu and hit "Print." This will take the form out of Form mode and turn it into a workable, combinable pdf.