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Get PUBLIC HEALTH SERVICE (PHS) DISCLOSURE FORM

T children) have a Significant Financial Interest consisting of one or more of the following that reasonably appears to be related to your University s responsibilities. (Please see the University s policy on Financial Conflicts of Interest for definitions.) Yes NO (If Yes, please check all that apply) Remuneration from a publicly traded entity exceeding $5,000.00 in the twelve months preceding this disclosure. Remuneration includes salary and any payment for services not otherw.

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