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Workforce Innovation and Opportunity Act
Conflict of Interest Policy Attestation

Please review the LWP Conflict of Interest Policy before completing this form. All required questions must be completed.
I do hereby attest and affirm that I have received, read, and understand the Lane Workforce Partnership (LWP) Conflict of Interest Policy and agree to be bound by it. I will promptly inform the LWP Board Chair of any material change that develops in the information contained herein.
1.I am a (select all that apply):(Required.)
2.Select ONE of the two options below:(Required.)
3.If you answered "I have a conflict to disclose", please briefly describe the potential conflict including the organization or individual involved and the nature of the relationship.
I understand that if I have a conflict of interest related to a matter before the Board, I will disclose the nature and extent of the conflict before discussion or voting occurs. I will not participate in the discussion or vote on the matter, except that I may respond to direct questions from other LWP Board Members.
4.Name (Required.)
5.Organization and Title(Required.)
6.Date(Required.)
Date