ETHICS DISCLOSURE FORM FOR NOMINATORS SSA Leadership Positions

INSTRUCTIONS: PLEASE RETURN THIS FORM WITH THE NOMINATION PACKAGE NO LATER THAN THE SPECIFIED REQUESTED DATE. IF YOU HAVE QUESTIONS, CONTACT NAN BROADBENT, SSA EXECUTIVE DIRECTOR, AT NBROADBENT@SEISMOSOC.ORG .

The Seismology Society of America (SSA) expects SSA Leaders to embody high standards of scientific integrity, personal accountability and ethics in their professional activities as set forth in SSA’s Professional Ethics Policy. Pursuant to the Professional Ethics Policy, SSA leaders includes members of the Board of Directors and committees as well as Associate Editors. In nominating someone to be an SSA leader, you play a vital role in upholding SSA’s professional ethics standards, and we ask that you supply the following information truthfully, to the best of your knowledge and ability.

Nominee Information

Begin typing the name of the institution to locate it within the database. If the institution name does not appear, please type the full institution name to add it to our database.

Nominator’s Declarations

1. To the best of your knowledge, has a court, regulatory agency, employer, or other public or private entity issued a finding against the nominee in which their professional conduct was at issue, including any instances of “Prohibited Conduct” as defined in Section E of SSA’s Professional Ethics Policy?

2. To the best of your knowledge, is the nominee currently under investigation by a court, regulatory agency, employer, or other public or private entity in which their professional conduct is at issue including any instances of “Prohibited Conduct” as defined in Section E of SSA’s Professional Ethics Policy?

Nominator’s Information & Acknowledgment