Your Details

Name
Your Relationship to the Organization

Disclosure

[Organization Name]'s conflict of interest policy asks staff, officers, board members, and volunteers to tell us about any financial interest, outside role, or personal relationship that could affect, or look like it affects, decisions they make for us. Read the full policy here: [link to policy].

Disclosing a conflict isn't a finding of wrongdoing. It lets us plan how to manage it. If you have nothing to report, answer No and sign below.

Questions? Contact [name, title] at [email].

Reason for This Disclosure
Do you have a conflict of interest to report?

Certification

Certification
Clear Signature

Board members, staff, and volunteers sometimes have ties that could affect the decisions they make for you. The Conflict of Interest Disclosure Form Template gives them a simple way to declare those ties, or confirm they have none, and sign the statement online.

Use it for annual conflict of interest statements, board member disclosure forms, staff declarations of interest, or related party disclosures at nonprofits, schools, associations, and businesses. Each submission gives whoever reviews disclosures a dated, signed record to work from.

How Does the Conflict of Interest Disclosure Form Template Work?

Here’s what’s in the form:

  • Your details: The respondent’s name, email, job title or position, and their relationship to your organization, such as employee, officer, board member, or volunteer.
  • Disclosure details: A short summary of your policy, the reason for the disclosure (annual, new, or an update), and a Yes or No question. A Yes opens questions about the type of conflict, the person or organization involved, and a description.
  • Certification: A checkbox confirming the information is accurate and complete, followed by a signature and the date signed.

You’ll get an email for each disclosure, and the respondent gets a copy. Swap in your own policy text and link, change the role choices, or add the PDF addon to save each signed statement as a PDF. Disclosure rules differ by organization type and location, so check the form against the requirements that apply to you.

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