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Summary: Form Revised 10.01.2010
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PLEASE USE THIS FORM IF YOU PLAN TO BE A CONSULTANT
University of Virginia School of Medicine
Approval of Outside Activities and/or External Consultancies Form
("AOA Form")
Name: _________________________ [printed]
Department:_____________________________
Administrative Contact:_______________________ [optional]
Date:______________________
School of Medicine policy requires that you complete this form (including the approval of your
Division or Department Chair) and submit it to the Office of Grants and Contracts for review and
approval prior to entering into an agreement with an external entity for consulting services or
other outside activities.. You will receive an initial response from the Office of Grants and
Contracts within five working days from the date of your submission. Expert witness/testimony
agreements will be processed by the General Counsel's office of the U.Va. Health Services
Foundation.
External Entity
Name: ________________________________
Address: ______________________________
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