Submit Disclosure

Please disclose all financial relationships you have had in the past 24 months with ineligible entities (definition below). For each financial relationship, enter the name of the entity and the nature of the financial relationship. There is no minimum financial threshold; we ask that you disclose all financial relationships, regardless of the amount, with ineligible entities. You should disclose all financial relationships regardless of the potential relevance of each relationship to the education. You do not need to disclose financial relationships of your spouse or partner.

Employee/Owner Entities*

Please list all companies or entities that you have an employee or ownership relationship with and what that relationship is.

List employee/owner relationships that have ended*

Grant/Research Entities*

Please list all companies or entities that you have had a grant/research support relationship with.

List grant/research support relationships that have ended*

Consultant/Advisory Board*

Please list all companies or entities that you have had a Consultant/Advisory Board relationship with.

List Consultant/Advisory Board relationships that have ended*

Non-Mutual funds Stock Ownership/Stock options*

Please list all companies or entities that you have had a Non-Mutual funds Stock Ownership/Stock options relationship with.

List Non-Mutual funds Stock Ownership/Stock options relationships that have ended*

Patent Holder/ Royalties*

Please list all companies or entities that you have had a Patent Holder/ Royalties relationship with.

List Patent Holder/ Royalties relationships that have ended*

Other financial or material support*

Please list all companies or entities that you have had a Other financial or material support relationship with.

List Other financial or material support relationships that have ended*

Name

This field is for validation purposes and should be left unchanged.

Abstract Questions