Board Conflict of Interest Policy

Click here to see or download a copy of the Delaplaine’s Conflict of Interest Policy.

Affirmation of Compliance and Disclosure Statement

  • I have received and carefully read the Conflict of Interest Policy for Board members, staff, and volunteers of The Delaplaine Arts Center (the Delaplaine) and have considered not only the literal expression of the policy but also its intent. By signing this affirmation of compliance, I hereby affirm that I understand and agree to comply with the Conflict of Interest Policy. I further understand that the Delaplaine is a charitable organization and that in order to maintain its federal tax exemption it must engage primarily in activities that accomplish one or more of its tax-exempt purposes. Except as otherwise indicated in the Disclosure Statement and attachments, if any, below, I hereby state that I do not, to the best of my knowledge, have any conflict of interest that may be seen as competing with the interests of the Delaplaine, nor does any relative or business associate have such an actual, apparent, or potential conflict of interest. If any situation should arise in the future which I think may involve me in a conflict of interest, I will promptly and fully disclose the circumstances to the Board Chair or to the CEO, as applicable. I further certify that the information set forth in the Disclosure Statement and attachments, if any, is true and correct to the best of my knowledge, information and belief.
  • Please complete the questionnaire below, indicating any actual, apparent or potential conflicts of interest. If you answer “yes” to any to the questions by checking the box, please provide a written description of the details of the specific action or transaction in the space allowed. Attach additional sheets as needed. Financial Interests – A conflict may exist where an interested party, or a relative or business associate of an interested party, directly or indirectly benefits or profits as a result of a decision made or transaction entered into by the organization. Please indicate, during the past 12 months:
  • If you checked any of the boxes above, please describe:
  • Other Interests – A conflict may also exist where an interested party, or a relative or business associate of an interested party, obtains a non-financial benefit or advantage that he would not have obtained absent his/her relationship with the organization, or where his/her duty or responsibility owed to the organization conflicts with a duty or responsibility owed to some other organization. Please indicate if at anytime during the past twelve months:
  • If you checked any of the boxes above, please describe:
  • Submitted by
  • Date
  • This field is for validation purposes and should be left unchanged.