Date:

To:          Christine S. Li, Ethics Liaison Officer

From:      NJIT Officer/Employee

Subject:  Recusal – Matter

This is to notify you that because I may be seen to have a conflict of interest in matters affecting (name of entity/individual), I understand that I may not participate in any way as an NJIT officer/employee in any matters regarding (entity/individual).

By copy of this memorandum, I am requesting that (name of administrative personnel if known) or any other designated staff person providing administrative assistance ensure that I am screened from any information or communications on any such matters and that I do not receive materials related to (entity/individual).

I understand that this recusal will remain in effect until I inform you in writing that all activity or connection with (entity/individual) has ceased or terminated.