disclosures: 05756221a9c742df16f3966a099045d7f6fb844e69e3e0abd05f64d45ac7d098
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| 05756221a9c742df16f3966a099045d7f6fb844e69e3e0abd05f64d45ac7d098 | 2017/Wigmore,_Danielle,_4.10.17_-_6.pdf | 2017 | STATE ETHICS RECEIVED COMMISSION FITCHBURG STATE UNIVERSITY MEMORANDUM 2017 APR 10 PM 12: 05 Date: March 21, 2017 To: Richard S. Lapidus, President From: Danielle Wigmore Department: Exercise and Sports Science Re: Disclosure of Decision to Adopt Instructional Materials in Whose Sale I Have a Financial Interest In compliance with the Massachusetts G.L.c.268A, §6, I disclose my intent to adopt the following: Semester: Fall Year: FY2017 (x) Day ( ) DCGE ( ) Non-Credit check all that apply Title: Advanced Cardiovascular Exercise Physiology by Smith and Fernhall Course Number/Name: EXSS 4045 Cardiovascular and Electrophysiology Full Description of materials (e.g., published text, course-pack, CD, etc.) (use reverse side of form if necessary): This is a published textbook If this is a published work sold to students through a 3rd party, such as a bookstore: Check all that apply ( ) I am the author () I am the editor (x) Other (I wrote chapters 9 & 10 of this book) () I am the co-author () I am the co-editor From sales of this title to Fitchburg State University students I anticipate that I will receive royalties in the amount of $0 . NOTE: Please be aware that faculty are prohibited from selling materials directly to students. In the event you determine that my financial interest is sufficiently substantial to warrant assigning to someone else the decision whether the instructional materials described above should be adopted for use in the course identified above, I agree to allow the Department Chair/Graduate Program Coordinator or designee to make that decision in my stead. danulle 121. line 3-21-17 Signature of Faculty Member Date Determination of Fitchburg State University Appointing Authority I have reviewed this matter and determine that the faculty member's financial interest as disclosed above is not sufficiently substantial to warrant my assigning to someone else the decision whether the instructional materials described above should be adopted for use in the course identified above. ( ) I have reviewed this matter and determine that the faculty member's financial interest is sufficiently substantial to warrant my assigning the decision in question to someone else. Therefore, in accordance with M.G.L.c.268A, §6, I assign that decision the appropriate administrative office. 3/28/17 Richard S. Lapidus, President Date Fitchburg State University Faculty Disclosure to the State Ethics Commission Checklist for Completing the University Disclosure Form Provide the information requested above the dotted line. Sign and date the form. Forward the form to the Office of the Vice President for Academic Affairs The form will be returned to you with the President's determination and signature. Make a copy for your files. Send the original to the Commonwealth of Massachusetts State Ethics Commission One Ashburton Place, Room 619 Boston, MA 02108 | 2017/Wigmore,_Danielle,_4.10.17_-_6.pdf |