Conflict of Interest Form - Cross Country

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School

Name of Person Completing This Form:

Title of Person Completing this Form

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List all officials that are affiliated with your school in any way, or that may have a conflict of interest with your school. This includes: (1) Currently employment in the district, (2) Previous employment in the district within the past ten years, (3) A close relative employed in the district, (4) A child attending any school in the district, (5) A graduate of school within the past ten years.

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Official's Name

I certify that I am authorized to complete this form on behalf of the school district.