Postdoctoral Fellowship Application

Conflict of Interest (COI) Disclosure Form

Name of Applicant: Title of Project/Proposal: Host Institution: Name of Supervisor/Mentor:

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1. Financial Interests

Do you or any immediate family members have any financial interests related to this fellowship or research? If yes, please describe:

2. Personal Relationships

Do you have any personal relationships that may influence or appear to influence your fellowship activities? If yes, please describe:

3. Academic Commitments

Do you have other academic, professional, or institutional commitments that may overlap with this fellowship? If yes, please specify:

4. Additional Disclosures

Are there any other potential conflicts of interest you wish to disclose?

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Date: Signature: