Dialogue Volume 12 Issue 2 2016 | Page 75

Conflict of Interest Form for Council Election Candidates I acknowledge that: • As a member of the College Council, my primary duty would be to serve and protect the public interest. • I have read and am familiar with the College’s Conflict of Interest Policy in the Governance Process Manual and Part 6 of the General By-Law (which addresses conflicts of interest)*. • I understand the principles of Conflict of Interest as set out in Part 6 of the General By-Law and the College’s Conflict of Interest Policy. • In the event I become a member of Council, I am bound to adhere to and respect the College’s Conflict of Interest Policy and Part 6 of the General By-Law. • Council members must avoid conflicts between their duty to the College and their self-interest or duty to another organization. In the space below, I have identified any relationship I currently have with any organization that may create a conflict of interest (by virtue of having competing fiduciary obligations to the College and the other organization), should I be elected to Council. This includes but is not limited to entities of which I am a director or officer. ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ Date: ___________________________________________________ Signature: _______________________________________________ Print Name: _____________________________________________ * The General By-law and Governance Process Manual can be found at www.cpso.on.ca Issue 2, 2016 Dialogue Issue2_16.indd 75 75 2016-06-16 12:28 PM