Council Elections - Conflict of Interest Declarations for Nominees

Council Elections - Conflict of Interest Declarations for Nominees

In accordance with section 16 of the bylaws of the College of Naturopaths of Ontario, you are required to disclose whether you, or one of your family members (patent, spouse, child or sibling) have any affiliations, interests or relationships that may impact or be perceived to impact your decisions.

About You

Please provide the following information about you and the positions you hold with the College.

First Name*

Last Name*

Nomination Tracking Number*

Please enter the tracking number provided for your on-line expression of interest form submission. It will start with NCF2022 - .

Registration Number*

Please enter your four digit registration number with the College of Naturopaths of Ontario.

Position*

As this is part of the election process, this declaration is used solely for the purposes of determining your eligibility for election.

Nominee for Election to Council

About Conflicts of Interest

A conflict of interest arises where you have a personal or professional interest which conflicts, might conflict or may be perceived to conflict with the interests of the College of Naturopaths of Ontario, including a conflict with your duties as a member of the Council, its Committees or as an employee or a person who is under contract with the College. A conflict of interest could arise in relation to personal matters including: • directorships or other employment; • interests in business enterprises or professional practices; • share ownership; • beneficial interests in trusts; • existing professional or personal associations; • professional associations or relationships with other organizations; and • personal associations with other groups or organizations, or family relationships. Any obligation, commitment, relationship or interest that could conflict or may be perceived to affect your judgment or the discharge of your duties to the College must be declared.

Part 1 - Disclosure of Appointed or Elected Offices Held

Appointed or Elected Offices outside of the College

Do you have a direct or indirect conflict with your duty as a member of one or more committees because you or a member of your family hold appointed or elected offices?

Yes

Title and Organization of Offices Held

Please provide the title of the office you or a family members holds and the name of the organization.

Title and Organization of Additional Offices Held

Please provide the title of the office you or a family members holds and the name of the organization if a second office is held.

Title and Organization of Additional Offices Held

Please provide the title of the office you or a family members holds and the name of the organization if a third office is held. If you or your family members hold more than three offices, please contact the College or provide the additional information by email to ceo@collegeofnaturopaths.on.ca.

Nature and Extent of Conflict

Please describe the nature and extent of the conflicting duty for each of the organizations set out above, as well as any additional ones about which you may be emailing the College.

Part 2 - Disclosure of Ownership or Possession of Outside Interests

Own or Possess outside Interests

Do you have a direct or indirect conflict with your duty as a member of one or more committees because you or a member of your family own or possess, directly or indirectly, interests outside of the College?

Yes

Interests Held

Please provide the type of interest held, i.e. shareholder, partner etc., and the organization in which you own or possess those interests.

Additional Interests Held

For any additional interests held, please provide the type of interest held, i.e. shareholder, partner etc., and the organization in which you own or possess those interests. If you have more than two, please email the information to ceo@collegeofnaturopaths.on.ca.

Nature and Extent of Holding Outside Interests

For each of the outside interests owned or possessed,. please describe the nature and the extent of the conflicting interest.

Part 3 - Disclosure of Financial Compensation Received

Compensation Received

Do you have a direct or indirect conflict with your duty as a member of one or more committees because you or a member of your family receive financial compensation (either for services performed, as an owner or part owner, trustee or employee) from an outside organization?

Yes

Financial Compensation

Please provide the Office or Position Title and the organization for which you receive financial compensation.

Additional Financial Compensation

For any additional positions, please provide the Office or Position Title and the organization for which you receive financial compensation. If you receive financial compensation from more than two organizations, please email information about any additional compensation received to ceo@collegeofnaturopaths.on.ca

Nature ane Extent of Conflict for Financial Compensation

For each organization from which you receive compensation disclosed, please describe the nature and extent of the conflict.

Part 4 - Disclosure of Relationships with External Organizations

Other External Relationships

Other than those disclosed above and in any follow up email to ceo@collegeofnaturopaths.on.ca, do you have any relationships or interests that could compromise or be perceived to compromise, your ability to exercise judgement or decision-making independently and objectively and with a view to the public interest and best interests of the College?

Yes

Outside Organization

Please provide the relationship with or interest in an outside organization, as well as the name of the organization.

Additonal Outside Organization

For any additional organizations, lease provide the relationship with or interest in an outside organization, as well as the name of the organization. If you have more than two, please email additional details to ceo@collegeofnaturopaths.on.ca.

Nature and Extent of Outside Organizational Conflict

For each organization disclosed, please describe the nature and extent of the conflict that arises or may arise.

Declarations and Signature

Please complete the following declarations and signature fields.

I so declare

Declaration

I hereby declare that the information that I have provided on this form and in any follow up email to ceo@collegeofnaturopaths.on.ca is complete and accurate to the best of my abilities.

Signature

By checking the box below, you are affixing a signature to this form and indicating that this form and the information contained herein is bound directly to you.

I affix my digital signature

Submission Copy

Below is a check box to receive a copy of your submission. It is highly recommended that you check this box and enter your e-mail address for a second time. This will enable the on-line system to send you a copy of the information that you have provided to the College.

Send me a copy of my responses

Privacy Notice|Report Abuse