____________________________________________________________ ____________________________________________________________ ____________________________________________________________ __________ ________________________________________ Date Signature of Chairperson or Assistant/ Associate Vice President E. Statement of Sr. Associate Dean/Academic Affairs I have reviewed this exemption request. I am aware of the nature of the conflict and the proposed measures to mitigate it. I am forwarding it to the Conflict of Interest Advisory Committee for its review, comments and suggestions. __________ ________________________________________ Date Signature of Sr. Associate Dean/Academic Affairs F. Statement of Dean I have reviewed this exemption request. I am aware of the nature of the conflict and the proposed measures to mitigate it. I am forwarding it to the Conflict of Interest Advisory Committee for its review, comments and suggestions. __________ ________________________________________ Date Signature of Dean FORWARD THIS FORM VIA CAMPUS MAIL TO ALISON J. WATKINS, UMB CONFLICT OF INTEREST OFFICER, ACADEMIC AFFAIRS, RESEARCH INTEGRITY OFFICE, FIFTH FLOOR, 620 W LEXINGTON BUILDING.
____________________________________________________________ ____________________________________________________________ ____________________________________________________________ __________ ________________________________________ Date Signature of Chairperson or Assistant/ Associate Vice President E. Statement of Sr. Associate Dean/Academic Affairs I have reviewed this exemption request. I am aware of the nature of the conflict and the proposed measures to mitigate it. I am forwarding it to the Conflict of Interest Advisory Committee for its review, comments and suggestions. __________ ________________________________________ Date Signature of Sr. Associate Dean/Academic Affairs F. Statement of Dean I have reviewed this exemption request. I am aware of the nature of the conflict and the proposed measures to mitigate it. I am forwarding it to the Conflict of Interest Advisory Committee for its review, comments and suggestions. __________ ________________________________________ Date Signature of Dean FORWARD THIS FORM VIA CAMPUS MAIL TO ALISON J. WATKINS, UMB CONFLICT OF INTEREST OFFICER, ACADEMIC AFFAIRS, RESEARCH INTEGRITY OFFICE, FIFTH FLOOR, 620 W LEXINGTON BUILDING.
coi_form_som.docx