Conflict of Interest Questionnaire
CONFLICT OF INTEREST
Pursuant to the purposes and intent of the Conflict of Interest Policy adopted by the Board of Trustees of Doane University in May, 2008 and revised in October, 2010, a copy of which has been furnished to me requiring disclosure of certain Covered Transactions by a Covered Individual. I hereby state that I or members of my family have the following affiliations or interests and have taken part in the following transactions that, when considered in conjunction with my position with or relation to Doane, might possibly constitute a conflict of interest.
*A Covered Individual’s family is defined as: spouse, parent, sibling, child, grandparent, grandchild, great grandchild, in-law or domestic partner, and spouses of brothers, sisters, children, grandchildren and great-grandchildren, or step-relative of any of the above.