2017-18 Annual COI Disclosure: UNM Investigators

Please complete this disclosure if you expect to participate in ANY research activities (funded or unfunded) at UNM Main Campus or Branch Campus/es in the 2017-18 academic year. This includes human subjects or animal subject research protocols.

If in the course of submitting your disclosure you need to stop and submit your disclosure at a later time, please follow these instructions.  Failure to follow them will result in loss of information entered.  Please select the SAVE DISCLOSURE command at the bottom of the page. Enter your email in the field and click SEND RETURN TICKET. Your responses will be saved and a return ticket link will be emailed to you.  Follow that link to access your survey again.

This COI disclosure is a confidential disclosure. Each disclosure will receive an initial review and you will be notified of that determination.  If the disclosure requires a review by the full COI Committee, you will be notified of their decision via email. You could be asked to be present at the Committee meeting.

If you have any questions while submitting your disclosure, please view the FAQ's listed on the Main Campus COI in Research webpage: http://researchcompliance.unm.edu/coi-disclosure-guidelines. If you still have questions, feel free to email us at coiresearch@unm.edu

1. 

Last Name:
First Name:
Email Address:
Primary Department:
Department Chair:
College Dean: 
Affiliated UNM Department/Center/Institute:
Academic/Professional Title:
Phone Number:

(Italicized print indicates a non-required field)

2. 

UNM Institutional/Research Responsibilities:  An investigator's professional responsibilities on behalf of the institution, including but not limited to, activities such as research, research consultation, teaching, professional practice, institutional committee membership, service on panels/boards, and administrative appointments. 

Please check all that apply.

Sponsored Research  
Non-Sponsored Research  
Public Service  
Teaching  
Service on panels/boards, i.e., Institutional Review Board, data security panels, etc.  
Committee Membership  
Administrative/Staff Duties  
Graduate Student Duties (please provide the degree being sought in the space provided below)  
Undergraduate Student Duties  
Other (please explain in the space provided below)  
 
3. 

Describe the subject area and focus of your UNM research.

 

UNM research means a systematic investigation designed to develop or contribute to generalizable knowledge, including basic and applied investigations and product development, that is:


1. Funded by or through UNM (including outside sponsored funding);
2. Conducted at UNM, regardless of funding; or
3. Non-sponsored and conducted off campus by UNM employees.
 
4. Does the research involve vertebrate animal subjects?
YES  
NO  
5. 

Does the research involve human subjects or identifiable private data?

YES  
NO  
6. Are you presently engaged in active UNM research projects?
YES  
NO