Nonprofit Conflict of Interest Certification Form

Name Position/Title Date

Disclosure of Possible Conflicts

List any relationships, transactions, or positions you hold (volunteer or paid) that could pose a possible conflict of interest with your position at this nonprofit organization.

List Conflicts

Certification

I certify that, except as described above, I have no conflict of interest to disclose.

I have read and understand the organization’s Conflict of Interest Policy.

I agree to comply with the policy and will report any changes promptly.

Signature Date