Nonprofit Board Conflict Check Form
Board Member Name
Email Address
Organization/Affiliation
1. Relationships & Interests
List any professional, personal, or financial relationships you or your immediate family have with organizations or individuals transacting with or seeking support from this nonprofit.
2. Potential Conflict Scenarios
Please check all that apply:
I or my family have a direct/indirect interest in a business transaction with this nonprofit.
I or my family may benefit from any organization grant, contract, or funding decision.
I or my family are employed by, or serve on the board of, an organization working with this nonprofit.
No known or potential conflicts at this time.
Provide further details or explanations, if necessary:
3. Disclosure & Attestation
I hereby disclose all potential or actual conflicts of interest to the best of my knowledge and agree to promptly update this form should my situation change.
Signature
Date