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VII.  POSITIONS HELD (YOU ONLY)

List positions held at any time during the current or previous year, as officer, director, proprietor, trustee, partner, representative, employee, or consultant of any corporation, company, firm, partnership, or other business enterprise, any non-profit or labor organization, or any educational, professional, cultural, scientific or other organization. 

Exclude: Positions in the Smithsonian or entities affiliated with the Smithsonian or federal government entities; organizations where you are only a member and do not hold any office; positions in religious, social, fraternal, political, neighborhood improvement or similar civic entities; and positions solely of an honorary nature.

[[3 column table]]

Name, Address and Nature of Organization | Position(s) Held
  |  |   
  |  |  
  |  | 
  |  |
[[image: square line box]] 'None] |  
[[/table]]

VIII.  CONTRACTS, AGREEMENTS, and ARRANGEMENTS (YOU ONLY)
Describe any existing agreement, contract or arrangement, verbal or written, that you have with a former, present, or future nonfederal employer; for a leave of absence during your Smithsonian service, continuation of payments, and participation in a pension or an employees' welfare or benefit plan maintained by a nonfederal former employer.  Also include agreements with any employer including the Smithsonian or any unit or affiliate thereof for writing, teaching, lecturing, royalties, and contracts for consultantships or other services if not described in other Sections of this form.

[[4 column table]]
Date | Parties to Agreements | Terms and Nature of Agreement
   |   |   |
   |   |   | 
   |   |   |
   | [[image: square line box]] 'None]] |    |
[[/table]]

Statement:  I have read and understand the statement of my obligations as a Smithsonian Institution employee as explained on this form.  I also am aware of my obligation to discuss all conflicts of interest real or apparent, with the Smithsonian Ethics Counselor and to seek the advice of that officer before engaging in any transaction which does or might present such a conflict; and to furnish the Ethics Counselor with whatever additional information about the items reported he may need for his review and evaluation of the information on this form.

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CERTIFICATION
I certify that the statements I have made in each section of this form are true, complete and correct to the best of my knowledge and belief.

SIGNATURE [[blank line]]

OFFICE TELEPHONE [[blank line]]

OFFICE ADDRESS [[blank line]]

DATE [[blank line]]
[[/boxed]]

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REVIEWING OFFICIAL
The information contained in this report discloses no conflict of interest under applicable laws and Smithsonian standards.

SIGNATURE [[blank line]]

DATE [[blank line]]
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