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APPLICATION FORM <br />CONFLICT OF INTEREST DISCLOSURE FORM <br />Who needs to disclose? <br />• <br />Any board member, officer, director, or <br />• <br />administrator of your organization <br />When is disclosure required? <br />• <br />Any conflict or potential conflict of <br />• <br />interest, including familial <br />relationships <br />What are the mitigation <br />• <br />measures? <br />Explain how a conflict will be avoided <br />• <br /> <br />