Ethics Commission Compliance Information Form
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Faculty Member First Name:
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Faculty Member Last Name:
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Department:
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Office Phone Number:
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eMail address:
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Department Chair:
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Chair's Phone Number:
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Chair's eMail Address:
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Title of Book or other Intellectual Property:
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Publisher:
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In which course(s) will you assign this material?
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For which semester?
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--Please Select--
Fall 2012
Winter 2013
Spring 2013
Summer 2013
Fall 2013
Winter 2014
Spring 2014
Summer 2014
Fall 2014
Winter 2015
Spring 2015
Summer 2015
Fall 2015
Winter 2016
Spring 2016
Summer 2016
Fall 2016
Did you RECEIVE INCOME--in any form, whether royalties or other--from assigning your materials to your students?
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Yes
No
If any INCOME RECEIVED is donated to an SCSU fund for the benefit of students or to a 501 C3 entity, please specify. (As soon as possible, please forward to Academic Affairs, ENA210 a copy of your check or of the receipt for your donation.)
Explain and support the information that shows how the book or material meets either or both of the following guidelines established by the Connecticut State Ethics Commission.
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The materials are recognized as standard in the field:
Explain and support the information that shows how the book or material meets either or both of the following guidelines established by the Connecticut State Ethics Commission.
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The materials offer a unique perspective on the topic of study.
Southern Connecticut State University