New Jersey Administrative Code
Title 19 - OTHER AGENCIES
STATE ETHICS COMMISSION
Chapter 61 - STATE ETHICS COMMISSION
Subchapter 6 - ATTENDANCE AT EVENTS, ACCEPTANCE OF HONORARIA, ACCEPTANCE OF COMPENSATION FOR PUBLISHED WORKS, AND ACCEPTANCE OF THINGS OF VALUE
Section 19:61-6.8 - Approval request form
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 N.J.A.C. 19:61-6.4(f).
