Data Sharing Agreement
Conflict of Interest (COI) Form
1. Project Information
Project Title
Principal Investigator / Data Provider Name
Organization / Institution
2. Recipient Information
Recipient Name
Recipient Organization
Recipient Contact Email
3. Data Description
Type and Nature of Data to be Shared
Purpose of Data Sharing
4. Conflict of Interest Disclosure
Do you or any member of your team have any potential conflicts of interest related to this data sharing agreement?
No
Yes
If yes, please describe the nature of the conflict of interest
5. Acknowledgement and Signature
Name
Date