Conflict of Interest Disclosure Form
For Grant Applicants
Full Name
Position/Title
Organization
Date
Have you, your immediate family, or close associates had any financial, professional, or personal relationship(s) that may represent a conflict of interest related to this grant application?
Yes
No
If yes, please describe all relationships, activities, or circumstances that could influence or appear to influence your objectivity.
Additional Information (if any)
I declare that the information provided above is accurate to the best of my knowledge.
Signature