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38 <br /> APPENDIX 2: Conflict of Interest Disclosure Form s Orange COU!Vlt�l <br /> Partn6rshllp to <br /> 24 CFR 578. 95 (b) Continuum of Care board '° Erle Homelessness <br /> members. No Continuum of Care board member may <br /> participate in or influence discussions or resulting decisions concerning the award of a grant <br /> or other financial benefits to the organization that the member represents. <br /> Leadership Team members fill this form once per year; Coordinator keeps <br /> current year forms on file. <br /> Name <br /> Current Employer or Business <br /> Affiliation <br /> Position <br /> Other Activities <br /> Please include all employment, <br /> business, or financial interest which <br /> you or a member of your immediate <br /> family may have as an officer, <br /> director, trustee, partner, employee, <br /> or agent which might give a rise to a <br /> possible conflict of interest with the <br /> Orange County Partnership to End <br /> Homelessness. <br /> Charitable or Civic Involvement <br /> Please list all official positions which <br /> you or any member of your immediate <br /> family may have as a director, trustee, <br /> or officer of any charitable, civic, or <br /> community organization as well as <br /> any unofficial roles such as significant <br /> donor, volunteer, advocate, or advisor <br /> which might give rise to a possible <br /> conflict of interest with the Orange <br /> County Partnership to End <br /> Homelessness. <br /> If at any time there is a matter under consideration that may constitute a direct or <br /> indirect conflict of interest not listed on this form, it is your obligation to disclose the <br /> facts to the Leadership Team. <br /> I do hereby affirm that I have received and read the policy and I will adhere to the <br /> document's spirit, principles, and practices. <br /> Signature <br /> Date <br /> Page 14 of 22 <br />