important sources of information
Conflict of interest statement

One unique feature of this program is that it requires of each principal investigator that conflict of interest with the pharmaceutical industry must be disclosed up front. In order to apply for grant funding, each Principal Investigator must fill out and sign the following statement:

I [Principal Investigator's Name Here], declare that in the last three years I have had no conflicts of interest with the pharmaceutical industry, as outlined below, except for: [please detail].

I declare further that I have read the Conflict of Interest Policy (below) and in the event that I should be a successful grant recipient, I will abide by the conflict of interest policy for the duration of this grant.

_________________________________		_____________
Principal Investigator Signature		Date

Conflict of Interest Policy:

The Principal Investigator shall refrain from the following conduct:

1. Accepting any honoraria, gift or consulting fee from a pharmaceutical company;
2. Accepting compensation fro participation on an advisory board to a pharmaceutical company;
3. Accepting a grant for research on a specific pharmaceutical product or on any topic where the grant is funded solely by one or more pharmaceutical companies;
4. participating in an education program or conference funded wholly or in part by a pharmaceutical company where expenses of more than $25 are paid to the principal investigator; however a principal investigator may participate in an educational program or conference and accept reimbursement of travel, meal and lodging expenses if those expenses are paid for by his or her employer or by another funding source unrelated to a pharmaceutical company.

Please note: On a case by case basis, successful grant recipients may apply to the Grantor for an exemption to 1 through 4 above. The Grantor shall consult with the Special Committee before granting or denying an exemption.

Successful grant applicants must agree to abide by the conflict of interest policy for the duration of the grant funding.