ࡱ> 9<8 bjbj 4 r Elllll8$$$$c\l$$$$$ll4$Rll$,L4v^~0*l$$$$$$$$$$$$$$$$$$$$$$$ 2: University of Colorado Boulder Use of Self-Authored Instructional Materials Approval Form Because of the potential for a conflict of interest, all self-authored instructional materials being required or recommended in a faculty authors course must receive approval prior to adoption for course use. This applies to faculty authored, co-authored, or customized educational materials. It does not apply to situations which do not generate royalties/income or do not have the potential to generate royalties/income. The departments signature approval is required in order for a Conflict of Interest Disclosure of External Professional Activities report (DEPA) to be approved. After providing the necessary information, submit this form to your Department Head (Chairperson/Institute Director, etc.) for signature. For audit/inquiry purposes, retain the signed original for your files. (Note, review by department committee may be required; a signed copy filed with the department administrator may also be required). You will be asked to certify that you have received department approval when completing the annual DEPA report. Approval for this request should take into consideration the following factors: appropriateness for the course, appropriateness of alternative materials, cost to students, extent of commercial availability and general use, availability of library copies, projected amount of royalties from the course, donation of a portion of royalties commensurate with course size to a third party such as a student organization/ outside educational organization, etc. Facultys LAST Name ________________________ FIRST Name _________________________________ Primary Dept./Institute Affiliation at CU ____________________________________________________ Course Name: _________________________________________________________________________ Total Number of Anticipated Students per calendar year.______________________________________ Materials Description: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Additional Comments: (may include rationale for use, review comments, etc.) _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _____________________________________ ________________ Department Head Signature Date     COI@colorado.eduCurrent auth.2013/14ver.1 UZ       0 g p w X _ j k l x ~  k  ,-3=C_fluǼǼϸ˴ϬϬװםhB.hB.5 hu#hu#hu#hGhThz hhhh%Dh \h-Th HhB.h\hu7hUh HhU5CJaJh HhB.5CJaJ=Z l 3C  Ortuwxz{}~ $$Ifa$gdG dgdGgdB.$a$gdUu    %2NOhimqrsuvxy{|~ijzb^hT/h{KhT5B*CJOJPJQJ\aJphO&h{Kh5CJOJPJQJ\aJ&h{KhP5CJOJPJQJ\aJ h{K5CJOJPJQJ\aJ hGhTCJ$OJPJQJaJ$hTCJ$OJPJQJaJ$h0)lhPhAtjhAtUh].hhGh HhB. hB.5$vqomomokomogdkd$$Ifs0 (!U t0^64H4 saytT $IfgdG h].hAthPh0)l gdB.21h:p/ =!"#$%   $$If!vh#vB!#v:V s t0^65!5U4H4 sytTj 666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ OJPJQJ_HmH nH sH tH J`J Normal dCJ_HaJmH sH tH DA D Default Paragraph FontRi@R 0 Table Normal4 l4a (k ( 0No List 4@4 G0Header  H$6o6 G0 Header CharCJaJ4 @4 G0Footer  H$6o!6 G0 Footer CharCJaJR@2R G0 Balloon Text dCJOJQJ^JaJNoAN G0Balloon Text CharCJOJQJ^JaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! 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