CONFLICT OF INTEREST DISCLOSURE FORM
Red Oak Community School District
Use this form to disclose any actual or potential conflict of interest. Complete a separate form for each conflict, if necessary.
1. INDIVIDUAL INFORMATION
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Name: |
Position/Title: |
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Fiscal Year: |
Date Submitted: |
- DISCLOSURE STATUS
[ ] I have no actual or potential conflict of interest to disclose.
[ ] I have an actual or potential conflict of interest to disclose, as described below.
3. CONFLICT DETAILS (complete only if disclosing a conflict)
Individual, business, or organization involved:
______________________________________________________________________
Nature of the relationship or potential conflict (for example, family, financial, employment, ownership, or contractual relationship):
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
District matter, decision, or transaction affected:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Other relevant facts:
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