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2018 Focus Area Committee Conflict of Interest

Conflict of Interest / Civic Involvement / Member Certification / Confidentiality

Conflict of Interest Policy
Any member of IMPACT 100 Pensacola Bay Area who serves as an employee or a board member for a nonprofit organization or who is personally involved with the nonprofit organization’s IMPACT 100 2018 Grant Application, shall not serve on the committee reviewing the nonprofit organization’s grant application, but is entitled to vote without restriction at the annual meeting. In addition, a member of IMPACT 100 Pensacola Bay Area serving on a committee who has a significant relationship with anyone involved with a nonprofit whose application is before the respective committee shall disclose the individual’s role with the nonprofit to the committee below, not participate in the site visit for that respective nonprofit, and follow the direction of the committee chair when the nonprofit’s grant application is being discussed.
Contact Information
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First Name
Last Name
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If you need to change your email, please type in the new email in the Comment Block at the end of this form.
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Do you and/or any significant relationship have affiliations with nonprofit organizations (e.g. staff, board member, business, volunteer)? Please list civic involvement and civic leadership positions in Escambia & Santa Rosa Counties held by you or your significant relationships. Committee chairs will contact you regarding any potential conflicts of interest. Check none if no personal or significant relationships civic involvement to disclose.
My Disclosures
List any/all local organizations since the disclosures are reviewed for potential conflict of interests prior to reviewing grants applications.


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Significant Relationship(s) Disclosures
List any/all local organizations since the disclosures are reviewed for potential conflict of interests prior to reviewing grants applications.


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Member Certification & Confidentiality
I hereby certify that I have read and agree to the Conflict of Interest Policy. I pledge to hold confidential all proceedings and discussions of IMPACT 100 Pensacola Bay Area committees.
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First Name
Last Name

If you will be unable to attend your committee's first meeting please notify your committee chair.

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