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Conflict of Interest - USASBE

Conflict of Interest Policy & Disclosure

The Conflict of Interest Policy and Disclosure is required on an annual basis of all board members and of all elected or appointed leaders.  Should you identify a potential conflict mid-year, please resubmit this form with updated information.

Links to the following guiding documents are available on the USASBE website.  Please review them prior to completing this disclosure form.


1.Full Name(Required.)
2.Institution/Employer(Required.)
3.Elected or Appointed Role(s) within USASBE (please provide the specific role, committee, commission, SIG leadership role, etc.)(Required.)
4.Email (for contact for clarifying questions)
5.I have received and read a copy of the Conflict of Interest Policy and reviewed the guidance chart.(Required.)
6.I agree to comply with the policy.(Required.)
7.I have no actual or potential conflicts as defined by the policy.(Required.)
8.Disclose here, to the best of your knowledge:

1. Any entity in which you participate (as a director, officer, employee, owner, or member) with which USASBE has a relationship;
2. Any transaction in which USASBE is a participant as to which you might have a conflicting interest; and
3. Any other situation which may pose a conflict of interest.
9.By typing my name below, I acknowledge the answers above to be true and complete to the best of my knowledge.(Required.)