Conflict of Interest

INDIVIDUAL STATEMENT REGARDING CONFLICT OF INTEREST

I acknowledge that I have read and fully understand the Agency’s Conflict of Interest Policy.

I affirm that I am not currently engaged in any transaction, investment, or other matter that would result in direct or indirect personal gain or profit due to my role as a Board Member, Committee Member, or Employeeof the Agency.
I agree to disclose any existing relationships that may present a conflict of interest.
If a conflict of interest arises in the future, I will immediately discloseit in accordance with the Agency’s policy and abstain from any decision-making or voting that could result in personal benefit.

Disclosure of Conflicts of Interest

Please list any known or potential conflicts of interest below. If none apply, write N/A.

Name

Position

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Date