(To comply with the 1994 State Ethics Law, this form must be completed and approved prior to undertaking the activity for which the honorarium is to be paid.)

ETHICAL CONDUCT/CONFLICT OF INTEREST STANDARDS HONORARIUM AUTHORIZATION

Proposed Honorarium

  1. Employee to receive the honorarium:

     

  2. Form and dollar value of the honorarium:

     

  3. Person / organization providing the honorarium:

     

  4. What do you do in exchange for the honorarium?

     

     

     

     

  5. What date(s) and time(s) would you do the activities?

     

     

Employee's Certification

  1. The person, organization or company offering me honorarium for a speech, appearance, article or similar item or activity is not seeking or expected to seek contractual relations with Seattle College District VI in any transaction in which I am in a position to participate; and
  2. The person, organization or company offering the honorarium is not regulated by Seattle College District VI; and
  3. The person, organization or company offering the honorarium is not seeking or opposing or is not reasonably likely to seek or oppose enactment or adoption of administrative rules or action or POLICY changes by Seattle College District VI; and
  4. The speech, appearance, article, or similar item or activity that I have been asked to give, produce or engage in does not detract from or interfere with my duties and obligations to Seattle College District VI.

__________________________________________
Employee


__________________________________________
Signature


_____________________
Date






 

 


Agency Approval

Seattle College District VI hereby authorizes the activity as
described above as well as and the proposed receipt of the honorarium from
the person offering the honorarium in exchange for the activity as proposed above.




__________________________________________
Chancellor or Campus President Signature*


_____________________
Date

*Board of Trustee Chair or Vice Chair will approve Chancellor or other Board Members Requests




Companion Document : Pol400
Adoption Date : 1995/06/06
Revision Date : 0001/01/01