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DRAFT APPENDIX 3 - FORM TO REQUE

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DRAFT APPENDIX 3 - FORM TO REQUE Powered By Docstoc
					                Application to Undertake Private Consultancy Work (PC1)

                                             Notes for Guidance

  Please read the Policy for the Management of Academic Consultancy Activity before completing this form.

All academic staff wishing to engage in private consultancy or other external work activity are required to seek specific
approval from the Dean of their School before commencing such an activity.

City University London recognises that many members of staff wish to undertake consultancy or other external work
which may or may not be connected in some way with their activities as employees of City University London. Staff are
encouraged to undertake related activities, as not only do they enhance their professional portfolio, they represent an
important component of the contribution the University makes to society through the transfer of knowledge and
expertise to business, the community and the professions.

However, City University London academic staff are not permitted to undertake such activities without the appropriate
approval of their senior managers, and work must not either conflict or adversely impact on their duties as academics,
or the business of their School or the wider University.

Any academic wishing to undertake private work should submit Form PC1 to their Dean for approval, which is
used to record details of the planned consultancy work, as well as the decision taken as to whether the work
has been approved or rejected.

If an academic commences private work without obtaining prior approval from their Dean this will be
considered a breach of the University Policy for the Management of Academic Consultancy Activity, as well
as breaching academic terms and conditions of employment, and may lead to disciplinary action.

Form PC1 should NOT be used for any of the following work*:

       All research grants and contracts
       All services rendered contracts
       Miscellaneous projects that are not research or services rendered but are run through CREU. (Please check
        with CREU before undertaking a project to ascertain whether it requires approval.)

* Please complete an AGC Form instead, available from the Research & Grants Office at CREU

Summary of Process

1) The individual academic seeking approval should complete Section A and attach any relevant documentation
useful for the consideration of their private consultancy work.

2) The completed form should be sent to the Dean of School for consideration PRIOR to the commencement of any
private work, or PRIOR to the conclusion of any contractual discussions concerning private consultancy work with
external parties.

3) The Dean should consider all relevant factors in assessing the request and confirm his/her decision by completing
Section B.

4) The completed PC1 should be sent to the office of the PVC for Research and Internationalisation for record keeping
purposes (where it will be treated as confidential).

Additional Support and Advice

Academics wishing to act as private consultants are strongly encouraged to seek legal advice on the terms of any
consultancy contract entered into and to arrange personal insurance cover, otherwise their personal assets may be at
risk. Further advice on this and other matters relating to consultancy activity can be obtained from City University
Enterprises Ltd, a new subsidiary company of City University London, which has been created to help support
academic staff develop external private consultancy activity. CU Enterprises is also able to provide indemnity
insurance and offer administrative support to academics.




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                 Application to Undertake Private Consultancy Work (PC1)
       Section A: Application Details

 1    Name, Department, telephone extension and email address of the academic undertaking the consultancy



 2    Name and address of the sponsor(s) providing payment for the consultancy



 3    Nature of the core business of the sponsor



 4    Title of the project / Nature of work



 5    Expected total level of payment for work (e.g. Daily Rate & No. of Days)



 6    Period of project (include dates):



 7    Are any Intellectual Property Rights (including copyright) likely to arise from this project?



 8    Do you wish to use the results arising from this project for research and teaching purposes?



      Additional Statements requiring Confirmation                                                                    Yes/No

9    I confirm that the above private consultancy activity will be accomplished without any adverse impact on my
     core academic duties and responsibilities at City University London.

10 I confirm that no University facilities or resources (including power, space, equipment, consumables, email
   & telephone facilities and staff) will be used to fulfil the requirements of the above private consultancy work.

11 I confirm that no University trademarks or brands, including letterheads etc, and no University intellectual
   property will be used in fulfilling the requirements of the above private consultancy work.

12 I have read the City University London Policy on Intellectual Property Rights and confirm that my work on
   the above project will neither breach any terms of this policy nor result in any other party using any
   Intellectual Property belonging to City University London or third parties without prior permission or financial
   recompense where appropriate.

13 I acknowledge that City University London academics are required where appropriate to possess private
   professional indemnity insurance before seeking approval to undertake private consultancy;
     And (delete as applicable):
     I confirm that I possess private indemnity insurance which is sufficient to cover all potential damage or loss
     that I reasonably consider could be sustained as a result of negligence or other action in the course of
     performing the private consultancy. Or further to discussions with my Dean of School I confirm that no
     insurance provision is required due to the nature of the work and to this effect confirm that I have advised
     the client that I am not able to provide any insurance cover myself or through City University London or CU
     Enterprises Ltd (Please attach details.)
     I will arrange appropriate private indemnity insurance through City University Enterprises Ltd and provide
                                                       Page 2 of 4
    evidence of this before commencing any consultancy work.

14 I confirm that if approval is granted for me to undertake the above private consultancy then I do so in a
   private capacity and recognise I am not acting as an employee of City University London during that time.

15 I confirm that if, following approval, I should seek to sub contract any private consultancy work to another
   party then I do so at my own risk and acknowledge that City University London or City University
   Enterprises Ltd has no liability for such work.

16 I believe to the best of my intentions that the above consultancy activity is not of a high risk category

            If you have answered NO to any of the above questions you must arrange to meet with
            your Dean of School to discuss these issues prior to his/her formal consideration of
            whether the proposed consultancy or other related activities may be undertaken.

            If you do not have personal indemnity insurance (see above) your proposal will not be
            granted until you either arrange this and re-submit your application to your Dean, or you
            direct your application following consideration by your Dean through CU Enterprises Ltd
            who will arrange indemnity insurance for you prior to the commencement of any private
            work.


      Declaration

               I certify that to the best of my knowledge the information given above, together with
               any accompanying information, is complete and correct, and that the resources
               stated are adequate to undertake the consultancy proposed.


               ........................................................................   ..................................………
               Signature


               ........................................................................
               Name                                                                       Date




                                                                           Page 3 of 4
Section B: School Approval


     Part One – Confirmation of Assessment of Application

          I certify that I have read the above application and have assessed it on behalf of City
           University London.

     Part Two - Permission to Undertake Consultancy Approved:

          I agree to grant approval for this work to be undertaken on the following basis (please
           tick which apply):

           1a) Outside University related working hours: 

           1b) No more than 1 day per week (or equivalent) of University related working hours
           during the period stated above for the length of the consultancy contract. Please state
           agreed arrangements: 




          And I confirm that the following apply (please tick which apply)

           2a) I have seen evidence that the applicant possesses appropriate private indemnity
           insurance: 

           2b) the applicant does not possess appropriate insurance and will only be permitted to
           undertake the above consultancy contract following evidence submitted to me that s/he
           has been provided this by City University Enterprises Limited: 

     Part 3 – Permission to Undertake Consultancy Refused

          I decline to grant approval for this work to be undertaken for the following reasons and
           have informed the applicant accordingly:




     ………………………………………………….....

     Print Name



     ........................................................................   .....................................………..
     Signature of Dean of School (or Equivalent)                                Date




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