Group II Conflict of Interest Disclosure Statement

I am completing this disclosure statement to qualify for service as (check all applicable)^*

required

Audit Committee

Employee

FAE Board

FAE Curriculum Committee

FAE Scholarship Committee

MSF Board

NYCPA Board

NYCPA or FAE Finance Committee

NYCPA, MSF, or FAE Investment Committee

PAC Board

Volunteer check signer

Other (specify below)

1) I declare that I have read and will abide by the NYCPA Conflict of Interest Policy.^*

required

Yes

2) Have you or any Related Parties or Affiliated Organizations provided compensated services or property to Society in the past year?^*

required

Yes

If yes, please describe the nature of the services or property:

3) Have you or any Related Parties or Affiliated Organizations received a scholarship, grant, or other funding from MSF in the past year?^*

required

Yes

If yes, describe the nature of the funds:

4) With the exception of NYCPA membership and FAE courses at which you or a Related Party have been a paid attendee, have you or any Related Parties or Affiliated Organizations purchased services or property from the Society in the past year?^*

required

Yes

If yes, describe the purchased services or property:

5) Please indicate whether you or any Related Parties or Affiliated Organizations had, have, or will have any direct or indirect interest in any business transaction(s) in the past year to which the Society was or is a party?^*

required

Yes

If yes, describe the transaction(s):

6) With the exceptions of your NYCPA membership dues, FAE courses for which you or a Related Party have registered and travel advances, were you or any Related Parties or Affiliated Organizations indebted to pay money to the Society at any time in the past year?^*

required

Yes

If yes, please describe the indebtedness:

7) Other than travel reimbursements, in the past year, did you or any Related Parties or Affiliated Organizations receive, or become entitled to receive, directly or indirectly, any personal benefits from, or as a result of your relationship with, the Society that in the aggregate could be valued in excess of $1,000?^*

required

Yes

If yes, please describe the benefit:

8) Are you or any Related Parties or Affiliated Organizations a party to, or have an interest in, any pending legal proceedings involving the Society?^*

required

Yes

If yes, please describe the proceeding(s):

9) Are you aware of any other events, transactions, arrangements or other situations that you believe should be examined by the NYCPA President or other Presiding Officer in accordance with the terms and intent of the Policy?^*

required

Yes

If yes, please describe the situation(s):

*Enter Your Name^*

required

*Enter Date^*

required

By submitting this form, I HEREBY CONFIRM that I have read and understand the Policy and that, to the best of my information and belief, my responses to the above questions are complete and correct.

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Group II Conflict of Interest Disclosure Statement

2025-2026