University of Illinois

University Ethics Office

Blank Statement of Economic Interests Form

Click here to print and complete a blank form.

If you print a form from the above link, please be sure to document the following information in the blank space at the top of the page:

Name: First and Last

Home Mailing Address: This information will be used by the Office of the Secretary of State to mail you a confirmation of receipt.

Don't forget to sign and date your form and keep a photocopy for yourself!

All forms submitted on or before April 20, 2012 should be returned via US Mail to the University Ethics Office:

University Ethics Office
Human Resources Building, Room 20
One University Plaza, HRB 20
Springfield, IL 62703-5407

**For UIC and UIUC employees, there is no campus mail to the Ethics Office, so you MUST place your form in US Mail.

All forms submitted after April 20, 2012 should be mailed directly to the Office of the Secretary of State at:

Office of the Secretary of State
Ethics Section, Index Department
111 East Monroe
Springfield, IL 62756