Instructions on Completing the Conflict of Interest Disclosure form

Instructions for completing the RWU Conflict of Interest Disclosure Form:

  1. READ the Policy! If you have questions about filling out the disclosure form, you may refer to the Frequently Asked Questions section, or contact the Office of General Counsel X5379 for more information.

  2. All questions on the disclosure form are required. All “Yes” responses require an explanation. Skipping or failure to answer a question will prevent submission of the form. Any “Yes” responses without an explanation will be returned for completion.

  3. If you have additional information to disclose that will not fit in the box provided for the answer, please submit the following on a blank piece of paper [and send by interoffice mail to the Office of General Counsel Attn: Kathleen Chrupcala or email to]: your printed name, Division of Service (VP’s name), the number of the disclosure question you are responding to and your response.

  4. Electronic submission of the disclosure form is required. 

  5. IMPORTANT: For purposes of filling out the disclosure form, “Immediate family” is your spouse, or domestic partner (consistent with University health benefits policy and procedure) and dependent children, including stepchildren. 

  6. Due date:  June 1, 2017.