New Jersey Administrative Code › Title 19 - OTHER AGENCIES › STATE ETHICS COMMISSION › Chapter 61 - STATE ETHICS COMMISSION › Subchapter 6 - ATTENDANCE AT EVENTS, ACCEPTANCE OF HONORARIA, ACCEPTANCE OF COMPENSATION FOR PUBLISHED WORKS, AND ACCEPTANCE OF THINGS OF VALUE › Section 19:61-6.10 - Annual disclosure for scholarly capacity employees

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A State
				  official serving in a scholarly capacity shall disclose annually to his or her
				  department head any travel, subsistence or entertainment expenses, honoraria,
				  academic prizes, or other things of value related to activities performed in
				  his or her scholarly capacity received in the prior academic year (July 1st
				  through June 30th). The sources of all such expenses and things of value shall
				  be identified.
(b) A State official
				  serving in a scholarly capacity shall use the following form for his or her
				  annual disclosure. The completed forms shall be submitted to his or her
				  department head, and the form shall be kept on file for a period of five years.
				  Each State college and university shall forward copies of the forms to the
				  Commission on an annual basis.
Annual College and University Disclosure Form
Date of Statement___________
For Academic Year July 1, ___ through June 30,
					 ________
First Name
					 _________________________________________________
Last Name
					 _________________________________________________
Institution
					 _________________________________________________
Department
					 ________________________________________________
Position
					 ___________________________________________________
Daytime Telephone
					 __________________________________________
Email Address
					 ______________________________________________
Instructions: This form must be submitted pursuant to
					 19:61-6.1 0(a), which requires a
					 State official serving in a scholarly capacity to annually disclose to his/her
					 Department head any travel, subsistence or entertainment expenses, honoraria,
					 academic prizes or other things of value related to activities performed in a
					 scholarly capacity received in the prior academic year (July 1st through June
					 30th). Any benefit received related to your State position, and any outside
					 activity performed, while not acting in a scholarly capacity, must still be
					 reported pursuant to your institution's procedures, and on the forms required
					 by the State Ethics Commission. Enter "N/A" in any category in which you did
					 not receive benefits while acting in scholarly capacity during the covered
					 academic year.
Benefits Received
A. Travel, Subsistence and Entertainment
				  Expenses
Date Received Type of Benefit Amount Source Interested
					 Party*
1.
2.
3.
4.
B.
				  Honoraria, Academic Prizes or Other Things of Value
Date Received Type of Benefit Amount Source Interested
					 Party*
1.
2.
3.
4.
*Indicate whether the source of the benefit is an
					 interested party to your institution. "Interested party" means: 1) any person
					 or entity your institution regulates, licenses or supervises; 2) any grantee or
					 grantor to your institution and any employee, representative or agent thereof;
					 3) any supplier/vendor to your institution; 4) any advocacy group that
					 advocates or represents the positions of its members to your institution; 5)
					 any organization a majority of whose members fall under 1-4 above.
C. Assigned Educational Texts or
				  Materials
1. Do you assign educational books
				  or materials authored by you as a course requirement?
Yes_____ No______
2. If answer to question 1 is yes, do you
				  receive royalties from those educational materials?
Yes_____ No______
3. If answer to question 2 is yes, did you
				  donate those royalties?
Yes______ No______
4. If answer to 3 is yes, where were the
				  royalties donated?
__________________________________________________________
To the best of my knowledge and belief the information on
					 this form is true and accurate.
EMPLOYEE: _____________________________
					 Date:____________
Signature
I have reviewed the information contained on this
					 form.