United Way of Porter County (6/2017)
UNITED WAY OF PORTER COUNTY
Conflict of Interest Disclosure Statement
United Way of Porter County’s Code of Ethics outlines the organization’s Conflict of Interest policies and should be closely reviewed by all Board and Committee members, other volunteers and staff. It is understood that active volunteers may have other involvement in other areas. As a result, these volunteers simply need to disclose and withdraw from discussion and voting on potential conflicts. All known or potential conflicts should be disclosed below.
Conflict of Interest: In order to avoid any future conflicts, please answer the following
1. Are you or any member of your immediate family a board YES NO
member of a United Way of Porter County partner agency?
2. Have you or any member of your immediate family ever been YES NO
employed by a United Way partner agency?
3. Do you or any member of your immediate family have a YES NO
business interest as a supplier of goods or services to United
Way of Porter County or to a United Way partner agency?
4. Do you feel that you may have any situation that may appear YES NO
as a conflict of interest?
If you answered “yes” to any of the above questions, please give details in the space below.
I hereby affirm that, to the best of my knowledge, the information given above is complete and accurate.
PRINT NAME ___________________________________