Published: November 13, 2026
Use this form when beginning a covered role, annually thereafter, and whenever a relevant interest changes. Read the Conflict of Interest & Related Party Transactions Policy before completing it. Disclose a potential or apparent conflict even if you believe you can act fairly.
Print this page or save a private copy using your browser's Print command. This page does not collect or submit information. Return a completed copy privately to the unconflicted Board member responsible for disclosures. Do not post it publicly or send payment credentials, identity documents, or unnecessary personal information.
Your details
Name: __________________________________________________________
Organizational role: ______________________________________________
Disclosure year or date: __________________________________________
Safe contact method: _____________________________________________
Interests and relationships
Describe each relevant interest, the people or entities involved, their relationship to you, and the Cotton Branch decision or activity it could affect. Attach additional pages if needed. If none applies, write “None” for that category.
- Employment, consulting, ownership, investments, compensation, or financial interests in an entity that does or may do business with Cotton Branch.
- A spouse, domestic partner, household member, close relative, or related entity with a relevant organizational role, financial interest, contract, or benefit.
- Outside board service, vendor or donor relationships, gifts, loans, business opportunities, or other interests that could affect your judgment.
- Any other actual, potential, or apparent conflict, including a relationship that could affect independent oversight or compensation approval.
Details: _________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Acknowledgment
I have received and read the Conflict of Interest Policy. To the best of my knowledge, this disclosure is complete and accurate. I agree to update it promptly when circumstances change, disclose relevant interests before a decision, and follow the required recusal and independent review process. I understand that a disclosure is not itself approval of a transaction.
Signature: ______________________________________________________
Date: ___________________________________________________________
For the unconflicted reviewer
Date received and reviewer: _______________________________________
Review, recusal, or follow-up required: ______________________________
________________________________________________________________
Decision and relevant minutes or record reference: ___________________
________________________________________________________________
Keep completed disclosures in restricted organizational records under the Records Retention Policy. A concern about nondisclosure or an implicated reviewer may use the independent reporting route.