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Nsf Form 1230a - Confidential Conflict-Of-Interest Statement For Nsf Advisory Committee Members - National Science Foundation Page 2

Part 2: Positions and Arrangements

If any entity with which (i) you are now "connected", (ii) you are negotiating to become "connected", or (iii) you have

arrangement to become "connected" in the future has financial interests that could be affected by policy deliberations likely to

come before the Committee - describe all such interests. You are "connected" with any entity if you serve as an employee,

officer, director, trustee, general partner, agent, attorney, consultant, or contractor for that entity.

[EXAMPLES: (1) Is your employer one of NSF's current science and technology center grantees, and the Committee could

recommend funding levels for the science and technology center program? If so, name the employer and grant

involved.

(2) Are you an officer in a professional association that has directly negotiated with the NSF on an issue the

Committee is likely to discuss? If so, name the association and the issue involved.]

NONE

(Identify specific organization, or entity)

(Type of position, arrangement or other connection)

(Interest or issue involved)

Part 3: Other Interests or Relationships

Are you aware of any other interests, affiliations, or relationships you believe would impair your impartiality in any policy

deliberations likely to come before the Committee, or that would cause a reasonable person with knowledge of the relevant facts to

question your impartiality in such matter?

[EXAMPLE: Does your best friend stand to benefit by a change in NSF's administration of the program your committee is

NONE

advising? If so, briefly describe.]

If your designation as an advisory committee member gives you access to information not generally available to the public, you

must not use that information for your personal benefit or make it available for the personal benefit of any other individual or

organization. This is to be distinguished from the entirely appropriate general benefit of learning more about the Foundation,

learning from other advisory committee members, or becoming better acquainted with the state of a given discipline.

Nsf Form 1230a - Confidential Conflict-Of-Interest Statement For Nsf Advisory Committee Members - National Science Foundation Page 2