As a member of American Board of Professional Psychology Board of Trustees (“ABPP”/ “BOT”), I recognize that I owe duties of care and loyalty to the organization. One aspect of fulfilling those duties is to avoid conflicts of interest in which my allegiance might be split between an organization position or responsibility and some other professional, business, personal, or volunteer position, interest or responsibility. I understand that disclosure of actual or perceived conflicts is intended to assist ABPP in resolving conflicts of interest and the disclosing an actual or perceived conflict does not necessarily mean that a conflict of interest exists or that the conflict would unduly influence my actions or my ability to serve on the BOT or a BOT Committee or Task Force.
I have reviewed the ABPP Conflict of Interest and Duality Guidelines disclosing situations or areas in which it might even appear that I have conflicting duties to other entities. I invite any further review by the organization of any aspects of these situations or areas that might be considered appropriate. Also, I will take other necessary steps, such as avoiding deliberation and resolution of certain issues if those steps are necessary to protect against liability to the organization or to me arising from conflict of interest. I also recognize that conflicts may arise during the course of my tenure on the BOT as agenda items come before ABPP and that my personal circumstances may change over time. I will follow the ABPP Conflict of Interest and Duality Guidelines in discharging my duties as a member of the BOT.
* You must answer all questions on this form. If you check yes to any question, you must provide details in the space that follows.
For the purpose of this disclosure form, “immediate family member” includes a person’s spouse, domestic partner, or dependent children.
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