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Conflict-of-Interest Disclosure

Purpose

A required annual form for board members and directors to disclose personal, financial, or relational conflicts.

Name

Name: _________

Role: _________

Date: _________

Disclosure statements

Please describe any relationships, financial interests, or activities that could create a conflict with the organization’s mission or decisions.




Acknowledgment

I certify that the information above is complete and accurate to the best of my knowledge.

Signature: _________

Date: _________

Notes

  • Update this disclosure whenever new conflicts arise.
  • Recuse yourself from decisions where a conflict exists.
  • Store disclosures with governance records.