Integrity Agreement for Assessors
Please review and complete this agreement to confirm your commitment to integrity and impartiality in the assessment process.
Assessor Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Organization / Institution
*
Role in Assessment
*
Please Select
Lead Assessor
Co-Assessor
External Expert
Observer
Other
Assessment Title or Reference
*
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please indicate your level of agreement with the following integrity statements:
*
Rows
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I will assess all submissions impartially and without bias.
1
2
3
4
5
I will declare any potential conflicts of interest prior to the assessment.
6
7
8
9
10
I will maintain confidentiality of all assessment materials.
11
12
13
14
15
I understand that integrity is essential to the credibility of the assessment process.
16
17
18
19
20
I will not disclose assessment outcomes to unauthorized individuals.
21
22
23
24
25
Have you participated as an assessor in previous assessments?
*
Yes
No
Please declare any potential conflicts of interest related to this assessment (if none, write 'None').
*
Assessor Signature
*
Submit Agreement
Submit Agreement
Should be Empty: