NC Biotech - Life Science Economic Development
Collaborative Funding Grant
STATEMENT OF COMPLIANCE WITH UNIVERSITY/NON-PROFIT POLICIES
Name of University/Non-Profit Applicant:
Statement of Compliance with University/Non-Profit Policies,
including Conflict of Interest Policies
Name of principal investigator (the “PI”) at university/non-profit:
Name of partnering company (the “Company”):
The University/Non-Profit Official has been made aware of the relationship between the PI and the Company in their pursuit of the Collaborative Funding Grant, a grant jointly sponsored by the North Carolina Biotechnology Center and the Kenan Institute for Engineering, Technology, and Science at North Carolina State University. The Collaborative Funding Grant is designed to promote a project of commercial interest to (1) generate discoveries that the Company might develop further to stimulate economic development and create jobs and (2) promote long-term cooperation among North Carolina universities, non-profit research institutes, and biotechnology companies.
The University/Non-Profit Official has been made aware of the project being pursued by the PI and Company in their application for the Collaborative Funding Grant (the “Project”). The undersigned certifies that the PI and Project comply with all university/non-profit or related policies, including conflict of interest policies. Also, to the extent necessary, a management plan has been implemented
to mitigate any potential conflict of interest issues.
(Name of University/Non-Profit Official)
By:
(Signature of University/Non-profit Official
authorized to certify compliance with university/non-profit
policies, including conflict of interest policies)
Title:
Date:
NCBiotech CFG Program 05/2017
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