ࡱ> npm%` bjbjNN 7,, r r r r ~ j q q q MOOOOOO$hsq q s    MM d֬r M08q ;  t?q q q ss  q q q jjjnjjjn SAMPLE - REQUEST TO SERVE ON AN ADVISORY COMMITTEE OF AN OUTSIDE ORGANIZATION - OFFICIAL DUTY From: EMPLOYEES TITLE Subject: Request to Serve on an Advisory Committee of an Outside Organization To: Carlton Duncan, Deputy Ethics Counselor THROUGH: (Organizational Approval Channels) I have been invited by _________ of Carnegie Mellon University, Pittsburgh, Pennsylvania, to participate as a member of the Advisory Committee for the National Consortium on Violence Research (NCOVR). The purpose of this memorandum is to request your approval of my service as a member of this advisory committee. The Committee is scheduled to meet no more than twice a year at Carnegie Mellon University. I will be serving from July 1997 to July 1999, and anticipate spending approximately 50 hours official time a year on this. NCOVRS primary functions are to promote integrated, multidisciplinary research into the causes of violence; educate a new generation of research investigators; conduct outreach to policymakers and practitioners involved in dealing with violence; and institutionalize the research, education, and outreach functions in an ongoing organization. These objectives fit well with the mission of my organization, and the sharing of violence prevention information that would result from my participation as a member of the NCOVR Advisory Committee would be very beneficial to CDC. I understand that I cannot accept an honorarium for serving on this advisory committee; however, NCOVR will reimburse CDC for my travel expenses to these meetings. I am aware that NCOVR is funded through a Cooperative Agreement No. SBR-9513040 between the National Science Foundation and Carnegie Mellon University. I will not be participating in the business or internal affairs of NCOVR or taking any action in my official capacity at CDC that could be perceived as directly or predictably affecting the financial interest of NCOVR. Further, I will not have any decision-making authority over any grants or contracts administered by NCOVR. EMPLOYEES NAME TITLE NOTE: Service on an advisory committee requires a Conflict of Interest Waiver if the employee does not merely render advice, but actually has authority to execute decisions with respect to the property, personnel and legal obligations of the organization. S`hz! hhU\hU\5>*\ hU\5\ abcz{" # 8 9 y z `gdU\gdU\50P:pU\/ =!"#$% L@L Normal1$7$8$H$CJ_HaJmH sH tH DAD Default Paragraph FontRiR  Table Normal4 l4a (k(No List  abcz{"#89yz  !!!!!!!!!!!!!!!!!!!!!!!!abcz{"#89yz  000000000000000000000000abcz{"#89yz  00000000000000000000000h   8@0(  B S  ?#C#C#C#C#TC#C#C#C#TC#,$#,%###'#!GPWcco      OVam{{    9 *urn:schemas-microsoft-com:office:smarttagsState= *urn:schemas-microsoft-com:office:smarttags PlaceType=*urn:schemas-microsoft-com:office:smarttags PlaceName8 *urn:schemas-microsoft-com:office:smarttagsCity9 *urn:schemas-microsoft-com:office:smarttagsplace E     c 3   U\;,e OrBvA>@4 @UnknownGz Times New Roman5Symbol3& z Arial"haF [[!24d  2HP)?29SAMPLE - REQUEST TO SERVE ON AN ADVISORY COMMITTEE OF AN mhp8foc0Oh+'0D , <H h t <SAMPLE - REQUEST TO SERVE ON AN ADVISORY COMMITTEE OF AN mhp8 Normal.dotfoc04Microsoft Office Word@hx@l@x`~֬[GVT$m 8C&" WMFC =]lUT#m EMF]$I*U"   %  Rp@Times New Roman/ 0q00 0Gz Times ew Romanti5- 0Pˮ0H 0 LN0 dv%  TxX/@@L\SAMPLE 8H^<CCTTX/@@LP-!TtXZ/@@1L REQUEST TO SERVE ON AN ADVISORY COMMITTEE OF AN HCNHC8CCN8CHHCNHHHHHH'8NHHHN^^'CCCCN<HHTT[X/@@[LP  % TT</@@'LP ,TTE</@@'LP ,TF_ </@@F'LxOUTSIDE ORGANIZATION NHC8'HCNHMHH'CHC'NHTT`  </@@` 'LP-!TT  </@@ 'LP E)Rp@Times New Roman/@@ 'LP - TT>/@@LP - TT"/@@ LP - % Tl$/@@~LXFrom:7!2N% T"/@@~Lp EMPLOYEE S TITLEC_<CNHCC!8B'CCCTT"/@@~LP 5 % TT/@@LP - T {/@@dMLSubject: Request to Serve on an Advisory Committee of an Outside Organization822,,C,22,'28,!2,22,2H22'2#0C2NN,,2!,2H2'2,I"1,2-,22TT {/@@dLP , TT}/@@LP - TP+ a/@@J+LTo: Carlton Duncan, Deputy Ethics Counselor=2C,!22H22,,2H,320=2,'C222',2!TT, Y a/@@, JLP . % TcR/@@ L`THROUGH: (CNHNHMN!!TScP /@@S!LOrganizational Approval Channels)N,228,3!282H88,222H8277,'!% TTQ e} /@@Q LP - TTG/@@0LP - TI(/@@LLI have been invited by _________ of Carnegie Mellon University, Pittsburgh, 3,2,2-,222,2402322222222!C,!2-1,Z-22H22,!'08'22!22 TDb-/@@TLPennsylvania, to participate as a member of the Advisory Committee for the National 8,22(02,2,22-!,3,,,',N,N3,!2!2,I22'2"0C2NN,,!2!3,H,22, T/V /@@=LConsortium on Violence Research (NCOVR). The purpose of thisC22'2!2N22H2,2,,C,',,!,2!HCHHC!=3,22!22',2!2'TW /v/@@W Lp memorandum is to N,N2!-222N'2 T4 /@@QLrequest your approval of my service as a member of this advisory committee. The !,22,'022!-22!22,2!O0',!2,,,',N,N2,!2!2',22'2"0,2NN,,=2, T K /@@o LLCommittee is scheduled to meet no more than twice a year at Carnegie Mellon C2NN,,'',2,22,22N,,22&" WMFC ]N2!,2,2H-,,0-,!,C,!3-1,Y,22 T4 l /@@ QLUniversity. I will be serving from July 1997 to July 1999, and anticipate spendiH22,!'0 H2,',!321!!2N(2022222(202222,22,2,2,,'3,22T`m  /@@m LTng 21 T l /@@U 4Lapproximately 50 hours official time a year on this.,22!23N,,022222!'2!!,,N,,0-,!222'TT  l /@@ U LP r- TTn  /@@ LP - TL R /@@; ULNCOVR S primary functions are to promote integrated, multidisciplinary research into HCHHC!82!N,#0!22,22',!,22!2N2,2-2!,,2N22',22,"0",',,",222 TDT  /@@ TLthe causes of violence; educate a new generation of research investigators; conduct 2,,,2','2!22,2,,-22,,,,3,H1,3,!,222!!,'-,!,223,'1,3!',2222, T 8 /@@! Loutreach to policymakers and p22!,,,2222.0N,3,!(,222T 8 /@@! 4Lractitioners involved in dealing with violence; and !,,22,!'2222-222,,21H222,2-,,22 T(:  /@@ OLinstitutionalize the research, education, and outreach functions in an ongoing l2'222,-,2,!,',,",2,22-,22,2222!,-,2!22,22'2,2231231 TP / /@@ VLorganization. These objectives fit well with the mission of my organization, and the 2!2,2-,22=2,',22-,2,'!H,H22,N''222!O02"1,2-,22,222, T8 " /@@z 'Lsharing of violence prevention informat'2,!213!22,2,,3!,3-2222!2!N,Tt#  /@@# z 1Lion that would result from my participation as a 222,H222!,'2!!2NO03,!,2,22,', T m/@@ GLmember of the NCOVR Advisory Committee would be very beneficial to CDC.N,N2,!2!2,HCIHCH22'2"0C2NN,,H3222,2,#02,3,!,,2CHCTTn /@@n LP - TTw/@@`LP - T\y/@@XLI understand that I cannot accept an honorarium for serving on this advisory committee; 223,!',222, ,,222,,-,2,22222!-!2N!3!',!231222',22'2#1,2NN,, T` ]/@@F.Lhowever, NCOVR will reimburse CDC for my trave22H,2,!HCHHCH!,N22!',CHC!2!P0!-2,T! ]/@@! FLl expenses to these meetings.,32,2','22,',N-,21'TT]/@@FLP S. TT_/@@LP - TIC/@@,GLI am aware that NCOVR is funded through a Cooperative Agreement No. SBR ,N,H-!,2,HCIHC'!222,22!2312,C223,!,2,I2!,,O,2H28BCTTIiC/@@I,LP-!T|jC/@@j,L\9513040 2222222 TXE/@@WLbetween the National Science Foundation and Carnegie Mellon University&&WMFC]. I will not be 2,H,,22,H,22,8,,2,,72222,22,22C-"2,1,Y,22H22,!'0H222, T )/@@:Lparticipating in the business or internal affairs of NCOVR2,!,2,2122,22'3,''2!2,!2,-!!,!'3!HCHHCT N)/@@ L or taking any action in my 2!,221,40--222O/ Th+/@@ZLofficial capacity at CDC that could be perceived as directly or predictably affecting the 2!!,,-,2,,0,CHC2,,2222,2,",,2,2-'2!,,03!2!,2,,20-!!,,312, Te /@@CLfinancial interest of NCOVR. Further, I will not have any decision!2,2,,2,!,'3!HCIHC72!2,! H222,2,,403,,'22TTf  /@@f LP-!T N/@@ Lpmaking authority N,232,222!0 To /@@k3Lover any grants or contracts administered by NCOVR.@22,!,401",2'2!,22"-,',2N2',!,240HCIHCTTp  /@@p kLP - TT/@@LP - % T h/@@SLlEMPLOYEE S NAMEC^<CNHCC!8HH^DTT  h/@@ SLP 6 Tlj /@@LXTITLEmC'CCCTT j1 /@@ LP 5 % TTN/@@7LP - % TTP#/@@LP 6 T44/@@QLNOTE: Service on an advisory committee requires a Conflict of Interest Waiver if HNCC!8,,2,,2828282'2,2,2SS!",,-,88,,'2H28",!2"'8!,,,'!d22,," T86/@@RLthe employee does not merely render advice, but actually has authority to execute !8,-R822,,82,'82!S,,,2,,88,,282,,98!2,!82282'28!82, 2!2,2,,8", T&/@@ELdecisions with respect to the property, personnel and legal obligatioB8,,'28'H!8,,'8,,!"2!8,8,28,,!28,,'289,288,222822!1T'/@@' L`ns of the 8'2"!8, T!/@@x Lhorganization.2,228,2!28TT"W/@@"xLP 6 % TT/@@LP -% 666666666666666666666666666666666666 6 66 6  6 66 6  6 66 6  6 66 6  6 66 6 66666666666666666666  ~`."System-@Times New Roman- 2 ^^~SAMPLE   2 ^^~-U2 ^1^~ REQUEST TO SERVE ON AN ADVISORY COMMITTEE OF AN R            2 ^^~ - 2 m^~ 2 2 m^~ 3+2 m^~OUTSIDE ORGANIZATION      2 m^~- 2 m^~ @Times New Roman--2 m ^~OFFICIAL DUTY    - @ !o-@Times New Roman- 2 mQ^~  2 }^~  2 ^~ -2 ^~From:E  -%2 ^~ EMPLOYEES TITLEI     2 T^~ - 2 ^~ 2 M^~Subject: Request to Serve on an Advisory Committee of an Outside Organizationg            2 ^~  2 ^~ L2 +^~To: Carlton Duncan, Deputy Ethics Counselor            2 ^~ -2  ^~THROUGH: (  =2 !^~Organizational Approval Channels)f        - 2 ^~  2 ^~ }2 L^~I have been invited by _________ of Carnegie Mellon University, Pittsburgh,                 2 T^~Pennsylvania, to participate as a member of the Advisory Committee for the National            g2 (=^~Consortium on Violence Research (NCOVR). The purpose of this           &2 (A^~ memorandum is to     2 8Q^~request your approval of my service as a member of this advisory committee. The a          }2 GL^~Committee is scheduled to meet no more than twice a year at Carnegie Mellon          2 WQ^~University. I will be serving from July 1997 to July 1999, and anticipate spendia            2 W^~ng m Y2 f4^~approximately 50 hours official time a year on this.         2 f^~  2 v^~ 2 U^~NCOVRS primary functions are to promote integrated, multidisciplinary research into                  2 T^~the causes of violence; educate a new generation of research investigators; conduct             82 ^~outreach to policymakers and p       Y2 S4^~ractitioners involved in dealing with violence; and       2 O^~institutionalize the research, education, and outreach functions in an ongoing           2 V^~organization. These objectives fit well with the mission of my organization, and the             F2 '^~sharing of violence prevention informat       U2 1^~ion that would result from my participation as a n      v2 G^~member of the NCOVR Advisory Committee would be very beneficial to CDC.               2 ^~  2 ^~ 2 X^~I understand that I cannot accept an honorarium for serving on this advisory committee;              P2 .^~however, NCOVR will reimburse CDC for my trave       72 ^~l expenses to these meetings.p     2 ^~  2 !^~ v2 1G^~I am aware that NCOVR is funded through a Cooperative Agreement No. SBR             2 1^~-2 1^~9513040    2 AW^~between the National Science Foundation and Carnegie Mellon University. I will not be               b2 P:^~participating in the business or internal affairs of NCOVR      52 P^~ or taking any action in my       2 `Z^~official capacity at CDC that could be perceived as directly or predictably affecting the           p2 oC^~financial interest of NCOVR. Further, I will not have any decision         2 oD^~-%2 oI^~making authority   X2 3^~over any grants or contracts administered by NCOVR.           2 ^~  2 ^~ -"2 |^~EMPLOYEES NAME     2 $^~ 2 |^~TITLE4  2 ^~ - 2 ^~ - 2 ^~ 2 Q^~NOTE: Service on an advisory committee requires a Conflict of Interest Waiver if o              2 R^~the employee does not merely render advice, but actually has authority to execute                  s2 E^~decisions with respect to the property, personnel and legal obligatio               2 d ^~ns of the   2  ^~organization.    2 ^~ - 2 ^~ -~~^^~~^^~~]]~~]]~~]]~~]]}}]]}}]]}}\\}}\\}}\\}}\\}}\\}}\\||[[||[[||[[||[[||[[՜.+,D՜.+,h$ hp  ITSO ' :SAMPLE - REQUEST TO SERVE ON AN ADVISORY COMMITTEE OF AN TitleP 5= LanguageEnglish !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdfghijkloRoot Entry F cg֬qData  1TableWordDocument7SummaryInformation( tDocumentSummaryInformation8eCompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q