State officials shall use the following form to request approval to attend events.
REQUEST FOR APPROVAL FOR
ATTENDANCE AT EVENT
DEPARTMENT OF _________________________________________
Name _____________________ Division ________________________
Title __________________ Telephone ___________ FAX __________
E-mail address ______________________________________________
Event _____________________________________________________
Sponsor ___________________________________________________
Is the sponsor an "interested party"? Yes ____ No ____ "Interested party" means: 1) any person or entity your institution regulates, licenses or supervises; 2) any grantee or grantor to your institution and any employee, representative or agent thereof; 3) any supplier/vendor to your institution; 4) any advocacy group that advocates or represents the positions of its members to your institution; 5) any organization a majority of whose members fall under 1-4 above.
Is the State official a speaker, panel participant or resource person?
Yes _____ No ____
Is the sponsor an agency of the federal government, one or more other states or a political subdivision thereof? Yes _____ No _____
Is the sponsor a nonprofit organization? Yes ______No ______
If Yes, is the employee or agency a member? Yes _____No ____
Does the nonprofit organization have any contracts with the State?
Yes _____ No ______
Location __________________________________ Date(s) __________
Overnight accommodation required? Yes _______ No _______
Out-of-state travel required? Yes _______No ________
Estimated total costs? $___________
Breakdown of Costs: Transportation $_______ Meals $_____
Accommodations $____ Registration Fees $___
Agency to pay costs? Yes ________ No ________
Sponsor to pay costs? Yes _______ No ________
Employee to pay costs? Yes ________ No ________
Other person or entity to pay costs? Yes _____ No _____ If yes, note name below:
__________________________________________________________
Reason for attendance: _______________________________________
__________________________________________________________
__________________________________________________________
Will sponsor offer an honorarium or fee? Yes _______ No _________
Check: _____ Copy of invitation letter attached.
_____ Copy of agenda or other description of event attached.
____________________________________ _________________
Employee Signature Date
____________________________________ _________________
Supervisor's Signature and Approval Date
NOTE: Any substitutions or changes of circumstances must be reported to your ELO.
*****************************************************
SPACE BELOW FOR ELO USE ONLY
Attendance approved Yes _______ No ______ Note: Acceptance of honoraria or fees is not permitted.
Conditions:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________
Signature ________________________________ Date ____________
Ethics Liaison Officer
_____ Sponsor is an interested party and employee will be accepting event benefits as a speaker, panelist or resource person. A copy of form will be forwarded to the State Ethics Commission pursuant to 19:61-6.4(f).
N.J. Admin. Code § 19:61-6.8
See: 28 N.J.R. 4755(b), 29 N.J.R. 593(a).
Added the "Note" relating to substitutions or changes to the request form.
Amended by R.2004 d.390, effective 10/18/2004.
See: 36 N.J.R. 2316(a), 36 N.J.R. 4842(a).
Rewrote the section.
Amended by R.2006 d.292, effective 8/21/2006.
See: 38 N.J.R. 1804(a), 38 N.J.R. 3318(a).
Section was "Sample approval request form". Rewrote the section.
Amended by R.2010 d.283, effective 12/6/2010.
See: 42 N.J.R. 1014(a), 42 N.J.R. 2980(a).
Deleted designation (a); and rewrote the approval form.