平成年度利益相反自己申告書（質問票）.docVIP

Self－declaration of conflict of interests (Questionnaire) for the year 2014 and 2015(the 26th and 27th year of Heisei) Q1: Are you engaged in any cooperative activities between industrial and academic societies as of the date of this declaration? Or are you going to be engaged in from now onward? 　If ‘Yes’(engaged or planned to), proceed to Q2. 　If ‘No’(not engaged, nor planned to), answers to the following questions are not necessary. Put your signature at the end of the answer sheet before submitting. In this questionnaire, cooperative activities between industrial and academic societies are defined as: for the purpose of social or practical use of intellectual property owned by Kyushu University, working with other organizations outside Kyushu University in the following activities. (national organizations, local government organizations, universities, cooperative university institutes, technical colleges, national government-related research development institutes, public test research institutes, governmental corporations and independent administrative corporations who operate research development are excluded.) Hereafter referred to as a cooperative partner. Joint research: under a joint research agreement, Kyushu University and a cooperative partner work together on a common subject. (Recipience of monetary contribution is not defined as joint research.) Contract research: under a contract research agreement, Kyushu University, on its own, works independently on research on commission from a cooperative partner. (Recipience of monetary contribution is not defined as contract research.) Technical guidance: under a technical guidance agreement, Kyushu University assists in the business and activities of an agreement party, through guidance and advice based on its special knowledge in education, research, and technics. Clinical research: clinical investigation, clinical tests, and other research conducted on humans; medical