Page 59 - FGLN SC Onboarding Binder 2021

Flint & Genesee Literacy Network Conflict of Interest Survey
Name: (please print)
1. Financial Interest.
Pleasediscloseanyemploymentorfinancialinterestwhichyouoramemberofyourimmediate familyhaveaseitheran officer, director, partner, employee or agent of an organization, which might give rise to a possible conflict of interest between you and Flint & Genesee Literacy Network:
2. Business Affiliation.
Please disclose any business affiliation, substantial interest or dealings or ownership interest of 5% or more which you or a member of your immediate family have in or with any business organizations which might give rise to a possible conflictofinterestbetweenyouand Flint & Genesee Literacy Network:
3. Community Involvement.
Please disclose all positions you or any member of your immediate family may have as a director, trustee or officer of any charitable, civic or community organizations that might give rise to a possible conflict of interest between you and Flint & Genesee Literacy Network:
Please use the back of this survey for any additional disclosures. Please return this completed form to the Flint & Genesee Literacy Network Operations Coordinator.
Reminder: Ifatanytimethereisamatterunderconsiderationthatmayconstituteadirector indirectconflictofinterest, itisyourobligationtodisclosethefactssurroundingthepossible conflictofinterest,toabstainfromvoting,andtorefrain fromusingyourpersonalinfluenceon thematter.
Signature Date
Please complete and return to Jessica Kitchner | Jessica.kitchner@mcc.edu