School Board Conflict of Interest Disclosure Form
Full Name
Position/Title
Date
School / District
Conflict of Interest Disclosure
1. Description of Potential Conflict(s) of Interest
2. Nature of Relationship or Financial Interest
3. Names of Individuals/Entities Involved (if any)
4. Steps Taken to Avoid/Address the Conflict
Certification
I certify that the information provided above is true and complete to the best of my knowledge.
Signature
Date