Confidentiality and Conflict of Interest Form



Name(Required)
I have a financial and/or policy-making interest related to the following organizations and individuals who applied for the 20-Minute Grant:(Required)
This means you’ve got a current verbal or written agreement to be paid by the applicant–or that you currently serve on a leadership group related to their work. (Being paid as an artist by the applicant in the past is not a conflict, so no need to list in that case!) Please enter “None” if you have no conflicts to disclose here. To add lines for multiple disclosures, please use the plus sign next to the first entry.
Members of my immediate family or household have a financial or policy-making interest related to the following organizations and individuals who applied for the 20-Minute Grant:(Required)
Please follow the same guidelines here as in the last question.
MM slash DD slash YYYY