Gift and Entertainment Conflict Disclosure Statement

All employees, board members, and volunteers of the organization are required to disclose any gifts or entertainment received from vendors, donors, clients, or other outside parties that could present a potential conflict of interest.

Personal Information

Full Name

Position / Title

Date

Gift or Entertainment Details

Description of Gift or Entertainment

Name of Person/Organization Giving the Gift

Relationship to Organization

Estimated Value

Date Received

Reason for Acceptance / Decline

Provide reason for accepting or declining the gift/entertainment

Does this gift or entertainment have the potential to influence your decision-making or create a perceived conflict of interest?

Additional Comments or Disclosure

Signature Date