Blank Form (only to be used by those filing from outside the US)

The preferred filing method is online. Only those individuals who are filing outside of the United States should print and complete a blank 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
  • Job Title: List the title of your position at the University of Illinois
  • Full 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 paper filings must be mailed to the University Ethics and Compliance Office for Ethics Officer review prior to being filed with the Secretary of State. All paper forms should be mailed to:

University Ethics and Compliance Office
Human Resources Building, Room 20
One University Plaza, HRB 20
Springfield, IL 62703

Employees who submit a paper form must ensure delivery to the University Ethics and Compliance Office by no later than April 29, 2022 to guarantee delivery to the Secretary of State by the deadline. Penalties will ensue for any forms received and filed after the May 1st deadline. Once forms have been filed with the Secretary of State, filers will receive written confirmation via US Mail to the address listed on their form.

 

For information specific to the Supplemental Statement form, please visit the Supplemental Statement of Economic Interest Form page of our website.