Conflict of Interest Questionnaire
For Nonprofit Grantees
1. Organization Information
Organization Name
Name of Person Completing This Form
Title/Position
Email
Date
2. Conflict of Interest Disclosure
Are any members of your board of directors, officers, key staff, or their immediate family members affiliated with our foundation (either as employees, board members, or consultants)?
Yes
No
If yes, please describe the relationship(s) and provide names:
Does your organization or any of its key personnel have personal, business, or financial interests that may be considered a conflict with this grant?
Yes
No
If yes, please explain:
Please describe your organization’s process for identifying and managing potential conflicts of interest:
3. Certification
I certify that the information provided in this questionnaire is accurate and complete to the best of my knowledge.
Signature
Date