SIU School of Medicine

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Forms and Policies

In order to identify and resolve all potential conflicts of interests we ask that presenters and planners complete the Conflict of Interest Disclosure Form. For your convenience it is available as a fillable pdf document, editable on your computer. Please submit it as an attachment to an email addressed to Laura Worrall ( at least 1 month prior to the activity.It is recommended that you save a copy for any modifications that you may need to make for future presentations.

SIU School of Medicine Faculty and Staff please use the
SIU SOM Conflict of Interest Website >

Conflict of Interest Disclosure & Attestation Form   [ MS Word ]
Conflict of Interest Policy [ PDF ]  
Honorarium and Reimbursement Policy [ PDF ]  
Policies on Industry Relations [ PDF ]  
Policy on Marketing Presentations [ PDF ]  
AC Standards for Commercial Support [ PDF ]  
Letter of Agreement for Commercial Support   [ MS Word ]
Regularly Scheduled Series (RSS):    
Requirements For Regularly Scheduled Conferences
Sponsored By SIU School Of Medicine Departments

[ PDF ]  
Requirements For Regularly Scheduled Conferences
Jointly Sponsored With Other Organizations
[ PDF ]  
RSS Session Planning Form (Discussion Series)   [ MS Word ]
RSS Session Planning Form (Speaker Based Series)   [ MS Word ]
RSS Conflict of Interest Form   [ MS Word ]
RSS Case Conference Disclosure/Attendance Form   [ MS Word ]
RSS Evaluation Template   [ MS Word ]