Employee Financial Conflict of Interest Form

MCCC Policy requires that every MCCC Board member fill out a Conflict of Interest Form annually.

This field is for validation purposes and should be left unchanged.

Please use this form to describe any possible financial conflict(s) of interest you may have in your service to the MCCC. (We need responses to all items except #8).

1. Click to Read The MCCC FINANCIAL CONFLICT OF INTEREST POLICY FOR MCCC OFFICIALS in a New Window or Tab:

2.(Required)

I have read the Financial Conflict of Interest Policy

3.(Required)

(Please use the name we should have on file for you)

First Last

4.(Required)

I have no conflict of interest to report.

I have the following conflict (or possible conflict) to report.

For reporting any conflicts

5. (Required)

6. (Required)

State reporting requires the current home address of all Board members.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

7. (Required)

Personal Email preferred

Enter Email Confirm Email

Other pertinent information that you may wish to submit.

Upon submission a copy of this information is emailed to the MCCC Office Manager or designee.

Employee Financial Conflict of Interest Form

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