UNIVERSITY OF HOUSTON-VICTORIA
Related Party Disclosure Form

A Related Party Disclosure is a question of fact that results when an individual is in a position to personally benefit from transactions entered into by the University of Houston-Victoria or other System component.  Transactions include, but are not limited to originating purchase requisitions, influencing purchasing decisions, and consulting or professional relationships.

Policy
Employees of the University of Houston-Victoria shall avoid using their positions for purposes that are, or give the appearance of being, motivated by a desire for private gain for themselves or others, such as those with whom they have family, business, or other ties.  University employees shall exercise the utmost good faith in all transactions, activities, and behaviors related to their duties to the UH System, its property, and resources.  Faculty and staff in a position to personally benefit from a transaction entered into by the University of Houston-Victoria or other UHS components shall annually complete a disclosure statement regarding related party interests as required by UHS Administrative Memorandum 02.A.10.

The Related Party Disclosure Form is to be completed by employees falling within any of the following categories:

(a) employees who have previously disclosed a related party interest;
(b) employees who will serve in a supervisory capacity at a department level or higher in the coming fiscal year;
(c) employees who will be in a position to make final purchasing decisions. This category includes all delegated departmental purchasers and ProCard users;
(d) employees having signature authority on any university cost center;
(e) employees who could personally benefit from a relationship or business transaction.

Confirmation and Disclosure Statement
I have read the University of Houston System Administrative Memorandum 02.A.10 and the University of Houston-Victoria policy, E-7, regarding disclosure of related-party interests and understand my responsibility to disclose such activities and relationships. Except as described below, to the best of my knowledge, within the past year neither I nor any close member of my family have had any related party transactions or relationships. In addition, except as described below, I am not involved in or aware of the involvement of other faculty or staff in any activities or organization which are related-party transactions or relationships.