{"id":1700,"date":"2023-03-24T11:02:35","date_gmt":"2023-03-24T15:02:35","guid":{"rendered":"https:\/\/carleton.ca\/deputyprovost\/?page_id=1700"},"modified":"2025-07-28T09:51:27","modified_gmt":"2025-07-28T13:51:27","slug":"conflict-of-interest-declaration-form","status":"publish","type":"page","link":"https:\/\/carleton.ca\/deputyprovost\/conflict-of-interest-declaration-form\/","title":{"rendered":"Conflict of Interest Declaration Form"},"content":{"rendered":"\n<section class=\"w-screen px-6 cu-section cu-section--white ml-offset-center md:px-8 lg:px-14\">\n    <div class=\"space-y-6 cu-max-w-child-5xl  md:space-y-10 cu-prose-first-last\">\n\n            <div class=\"cu-textmedia flex flex-col lg:flex-row mx-auto gap-6 md:gap-10 my-6 md:my-12 first:mt-0 max-w-5xl\">\n        <div class=\"justify-start cu-textmedia-content cu-prose-first-last\" style=\"flex: 0 0 100%;\">\n            <header class=\"font-light prose-xl cu-pageheader md:prose-2xl cu-component-updated cu-prose-first-last\">\n                                    <h1 class=\"cu-prose-first-last font-semibold !mt-2 mb-4 md:mb-6 relative after:absolute after:h-px after:bottom-0 after:bg-cu-red after:left-px text-3xl md:text-4xl lg:text-5xl lg:leading-[3.5rem] pb-5 after:w-10 text-cu-black-700 not-prose\">\n                        Conflict of Interest Declaration Form\n                    <\/h1>\n                \n                                \n                            <\/header>\n\n                    <\/div>\n\n            <\/div>\n\n    <\/div>\n<\/section>\n\n\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar 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Conflict of Interest and Confidentiality Declaration<\/h2>\n                            <p class='gform_description'>This form must be completed by all external referees and approved by the Faculty Dean\/University Librarian at Carleton University before any promotion dossier is released for review.<\/p>\n                        <\/div><form class='not-prose' method='post' enctype='multipart\/form-data'  id='gform_9'  action='\/deputyprovost\/wp-json\/wp\/v2\/pages\/1700' data-formid='9' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_9_14\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Section A<\/h3><\/div><div id=\"field_9_15\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><strong>External Referee:<\/strong><\/div><div id=\"field_9_2\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_2'>Referee&#039;s Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_9_2' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_6\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_6'>Referee&#039;s Institution:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_9_6' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_46\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_46'>Referee&#039;s Country:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_9_46' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_50\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_50'>Referee&#039;s Academic Rank (ie, Associate, Full):<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_50' id='input_9_50' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_16\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><strong>For the Promotion Consideration of:<\/strong><\/div><div id=\"field_9_17\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_17'>Candidate&#039;s Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_9_17' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_49\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_49'>To the Rank of:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_49' id='input_9_49' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Assistant Professor, Teaching Steam' >Assistant Professor, Teaching Steam<\/option><option value='Associate Professor, Teaching Stream' >Associate Professor, Teaching Stream<\/option><option value='Full Professor, Teaching Stream' >Full Professor, Teaching Stream<\/option><option value='Associate Professor' >Associate Professor<\/option><option value='Full Professor' >Full Professor<\/option><option value='Chancellor&#039;s Professor' >Chancellor&#039;s Professor<\/option><\/select><\/div><\/div><div id=\"field_9_47\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_47'>In the Faculty of:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_47' id='input_9_47' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Engineering and Design' >Engineering and Design<\/option><option value='Science' >Science<\/option><option value='Public and Global Affairs' >Public and Global Affairs<\/option><option value='Arts and Social Sciences' >Arts and Social Sciences<\/option><option value='Sprott School of Business' >Sprott School of Business<\/option><\/select><\/div><\/div><div id=\"field_9_42\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_42'>Academic Unit<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_42' id='input_9_42' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Department of Mechanical and Aerospace Engineering' >Department of Mechanical and Aerospace Engineering<\/option><option value='Department of Electronics' >Department of Electronics<\/option><option value='Department of Civil and Environmental Engineering' >Department of Civil and Environmental Engineering<\/option><option value='Department of Systems and Computer Engineering' >Department of Systems and Computer Engineering<\/option><option value='School of Industrial Design' >School of Industrial Design<\/option><option value='School of Information Technology' >School of Information Technology<\/option><option value='Azrieli School of Architecture and Urbanism' >Azrieli School of Architecture and Urbanism<\/option><\/select><\/div><\/div><div id=\"field_9_43\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_43'>Academic Unit<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_43' id='input_9_43' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Institute of Biochemistry' >Institute of Biochemistry<\/option><option value='Department of Biology' >Department of Biology<\/option><option value='Department of Chemistry' >Department of Chemistry<\/option><option value='School of Computer Science' >School of Computer Science<\/option><option value='Department of Earth Sciences' >Department of Earth Sciences<\/option><option value='Institute of Environmental and Interdisciplinary Science' >Institute of Environmental and Interdisciplinary Science<\/option><option value='Department of Health Sciences' >Department of Health Sciences<\/option><option value='School of Mathematics &amp; Statistics' >School of Mathematics &amp; Statistics<\/option><option value='Department of Neuroscience' >Department of Neuroscience<\/option><option value='Department of Physics' >Department of Physics<\/option><\/select><\/div><\/div><div id=\"field_9_44\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_44'>Academic Unit<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_44' id='input_9_44' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Institute of Criminology and Criminal Justice' >Institute of Criminology and Criminal Justice<\/option><option value='Department of Economics' >Department of Economics<\/option><option value='Institute of European, Russian, and Eurasian Studies' >Institute of European, Russian, and Eurasian Studies<\/option><option value='Norman Paterson School of International Affairs' >Norman Paterson School of International Affairs<\/option><option value='Institute of Political Economy' >Institute of Political Economy<\/option><option value='Department of Law and Legal Studies' >Department of Law and Legal Studies<\/option><option value='Department of Political Science' >Department of Political Science<\/option><option value='School of Public Policy and Administration' >School of Public Policy and Administration<\/option><option value='School of Journalism and Communication - Communication' >School of Journalism and Communication &#8211; Communication<\/option><option value='School of Journalism and Communication - Journalism' >School of Journalism and Communication &#8211; Journalism<\/option><option value='School of Social Work' >School of Social Work<\/option><option value='Arthur Kroeger College of Public Affairs' >Arthur Kroeger College of Public Affairs<\/option><\/select><\/div><\/div><div id=\"field_9_45\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_45'>Academic Unit<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_45' id='input_9_45' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Institute of African Studies' >Institute of African Studies<\/option><option value='Department of Cognitive Science' >Department of Cognitive Science<\/option><option value='Institute of Comparative Studies in Literature, Art and Culture' >Institute of Comparative Studies in Literature, Art and Culture<\/option><option value='Department of English Language and Literature' >Department of English Language and Literature<\/option><option value='Feminist Institute of Social Transformation' >Feminist Institute of Social Transformation<\/option><option value='Department of French' >Department of French<\/option><option value='Department of Geography and Environmental Studies' >Department of Geography and Environmental Studies<\/option><option value='Department of History' >Department of History<\/option><option value='College of the Humanities' >College of the Humanities<\/option><option value='School of Indigenous and Canadian Studies' >School of Indigenous and Canadian Studies<\/option><option value='Centre for Initiatives in Education' >Centre for Initiatives in Education<\/option><option value='Institute of Interdisciplinary Studies' >Institute of Interdisciplinary Studies<\/option><option value='School of Linguistics and Language Studies' >School of Linguistics and Language Studies<\/option><option value='Department of Philosophy' >Department of Philosophy<\/option><option value='Department of Psychology' >Department of Psychology<\/option><option value='Department of Sociology and Anthropology' >Department of Sociology and Anthropology<\/option><option value='School for Studies in Art and Culture' >School for Studies in Art and Culture<\/option><\/select><\/div><\/div><div id=\"field_9_21\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Section B<\/h3><\/div><div id=\"field_9_22\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>Thank you for agreeing to serve as an external referee. Kindly complete this form as appropriate, so that the Faculty Dean\/University Librarian at Carleton University can consider any real, potential, or perceived conflicts of interest, and make any necessary recommendations.<\/p><\/div><div id=\"field_9_24\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><strong>DECLARATION<\/strong><\/div><fieldset id=\"field_9_23\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I have co-published with the applicant in the last six years.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_23'>\n\t\t\t<div class='gchoice gchoice_9_23_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Yes'  id='choice_9_23_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_23_0' id='label_9_23_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_23_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='No'  id='choice_9_23_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_23_1' id='label_9_23_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_25\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I have worked on a research grant or contract with the applicant in the last six years.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_25'>\n\t\t\t<div class='gchoice gchoice_9_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Yes'  id='choice_9_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_25_0' id='label_9_25_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='No'  id='choice_9_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_25_1' id='label_9_25_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_26\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I have supervised the applicant as a PhD student.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_26'>\n\t\t\t<div class='gchoice gchoice_9_26_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Yes'  id='choice_9_26_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_26_0' id='label_9_26_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_26_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='No'  id='choice_9_26_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_26_1' id='label_9_26_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I have acted as a research supervisor to the applicant in another capacity.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_27'>\n\t\t\t<div class='gchoice gchoice_9_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Yes'  id='choice_9_27_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_27_0' id='label_9_27_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='No'  id='choice_9_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_27_1' id='label_9_27_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_28\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I have been supervised by the applicant.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_28'>\n\t\t\t<div class='gchoice gchoice_9_28_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Yes'  id='choice_9_28_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_28_0' id='label_9_28_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_28_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='No'  id='choice_9_28_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_28_1' id='label_9_28_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_29\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I have common business interests with the applicant, or have had common business interests in the last six years.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_29'>\n\t\t\t<div class='gchoice gchoice_9_29_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='Yes'  id='choice_9_29_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_29_0' id='label_9_29_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_29_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='No'  id='choice_9_29_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_29_1' id='label_9_29_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_30\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I have plans to collaborate with the applicant in the next six months.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_30'>\n\t\t\t<div class='gchoice gchoice_9_30_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='Yes'  id='choice_9_30_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_30_0' id='label_9_30_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_30_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='No'  id='choice_9_30_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_30_1' id='label_9_30_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_31\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I have other conflicts of interests (personal, financial, etc) with the applicant.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_31'>\n\t\t\t<div class='gchoice gchoice_9_31_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Yes'  id='choice_9_31_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_31_0' id='label_9_31_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_31_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='No'  id='choice_9_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_31_1' id='label_9_31_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_9_32\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_32'>If you answered &quot;Yes&quot; to any of the statements above, please describe the real, perceived, or potential conflict of interest.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_32' id='input_9_32' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_9_51\" class=\"gfield gfield--type-email gfield--input-type-email field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_51'>Submitter email address<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_51' id='input_9_51' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_9_41\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2>Confidentiality Acknowledgement &amp; Undertaking<\/h2>\n<p>\nI understand that the integrity of the University and the review process depends on my participation in the review process being conducted in an impartial, ethical, confidential, and respectful manner. I hereby agree to:\n<p>\nRespect and maintain the absolute confidentiality of all applicants for tenure and\/or promotion. I will not reveal the name(s), or any information about such persons at any time;\n<p>\nKeep confidential all documents and information, whether in the form of papers, books, files, documents, electronic communications, or in any other form or format including oral communications, which comes into my possession or knowledge in my capacity as a committee member and relates to the promotion of the applicant;\n<p>\nKeep any downloaded documents secure and password-protected and not publicly accessible;\n<p>\nNot divulge, disclose, or communicate, in any form or manner, directly or indirectly, such confidential information to any person, firm, corporation, or other entity, other than a person otherwise designated by the University, to receive such confidential information;\n<p>\nEnsure that all materials in my possession are shredded and\/or digitally destroyed, as applicable at the end of the review process.\n<p>\nUpdated: August 16, 2016<\/div><fieldset id=\"field_9_40\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Do you agree to the above Confidentiality Acknowledgement &amp; Undertaking statement?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_9_40'><div class='gchoice gchoice_9_40_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.1' type='checkbox'  value='I Agree'  id='choice_9_40_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_40_1' id='label_9_40_1' class='gform-field-label gform-field-label--type-inline'>I Agree<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_9_38\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Privacy Statement<\/h3><div class='gsection_description' id='gfield_description_9_38'>The personal information requested on this form is collected in accordance with Sections 38(2) and 41(1) of the Freedom of Information and Protection of Privacy Act (FIPPA), R.S.O. 1990, c.F.31 as amended. The information provided will not be used for any purposes other than those stated upon this form. Should you have any questions concerning your personal information, please contact the Dean&#8217;s Office. 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