Conflict of Interest Form COMMIT TO LEAD Pleaser review the “Conflict of Interest Policy” and the “Nondisclosure Agreement” prior to submitting the Conflict of Interest Form. Conflict of Interest PolicyNondisclosure Agreement Name: * First Name Last Name Email: * Date: * MM DD YYYY Position: * Are you a Voting Director? (board members are considered "Voting Directors") * Yes No Are you an Officer? (Chair, Treasurer, Secretary): * Yes No If an Officer, what is your position?: I affirm the following: * I have reviewed the College Conflict of Interest Policy. I have read and understand the Policy. I agree to comply with the Policy. I have reviewed the Nondisclosure Agreement I agree to comply with the Agreement Do you have a financial interest (current or potential), including a compensation arrangement, as defined in the Conflict of Interest Policy with the College?: * Yes No If yes, please describe below: In the past year have you had a financial interest, including a compensation arrangement, as defined in the Conflict of Interest Policy with College?: * Yes No If yes, please describe it, including when (approximately): Are you an independent director, as defined in the Conflict of Interest Policy? * Yes No If you are not an independent director, please explain: Thank you!
