THE KU ALUMNI ASSOCIATION

CONFIDENTIALITY, CONFLICT OF INTEREST,

AND SECURITY AGREEMENT

This form is intended to emphasize the importance of three principles which are essential for the KU Alumni Association (Association) to fulfill its mission of supporting the University of Kansas. These principles are: 1) protect the confidentiality of Association information; 2) avoid situations where personal interests may conflict with Association interests; and 3) security of the Association’s building.

As an Association employee or member of its Board of Directors, you have access to information that is either confidential by law or by Association policy. You occupy a unique position of trust. Protecting information and avoiding conflicts of interest are central to maintaining that trust. Generally, all information concerning Association business relationships is confidential and must not be discussed with or released to other parties outside the Association. There are specific policies to guide those individuals who are authorized to release such information, and all inquiries should be referred to appropriate departments. The Communications Department can help you find the right people to respond when you receive such requests for information. Confidential information includes, but is not limited to, alumni records data, data processing security codes, and building entry and security information.

An actual or potential conflict of interest which you may have with the Associationshould be disclosed for resolution to your supervisor, the Association’s President or the Board Chair, as appropriate. A potential conflict of interest includes, but is not limited to, alumni contacts or solicitations on behalf of organizations other than the Association. The reverse of this form is used to provide this information.

You may also have been entrusted with keys or codes to the Association’s offices and files. Such keys and codes are for your individual use only, and you should not allow them to be used by a fellow employee, family member, or any other person without prior authorization by the Association’s President.

Please consider the following issues when considering your potential conflict of interest situations and provide details for all questions to which you respond “Yes” in the space below. For the purposes of completing this form, “Family Member” includes your spouse, ancestors, children, grandchildren, great-grandchildren, siblings, and the spouses of: children, grandchildren, great-grandchildren, and siblings. Also, “business relationship” does not include a relationship between an attorney and client, a medical professional (including psychologist) and patient, or a priest/clergy and penitent/communicant. Thank you.

Time Period: July 1, 2013 through the date signed ______
1) Did you or a Family Member receive payment from the Association for any business transaction, either directly or indirectly through a business entity? / □ No □ Yes
(please provide detail below)
2) Other than as a full-time employee of the Association, did you or a Family Member receive compensation from the Association that is reportable on Internal Revenue Service Forms W-2 or 1099? / □ No □ Yes
(please provide detail below)
3) Do you or a Family Member have employment or a business relationship with any other Association employee or Board member? / □ No □ Yes
(please provide detail below)
4) Do you or a Family Member have employment or a business relationship with any entity that is in competition with the Association? / □ No □ Yes
(please provide detail below)
5) Do you or a Family Member have employment or a business relationship with any entity that is in competition with the Association for the purchase or sale of property or services? / □ No □ Yes
(please provide detail below)
6) Do you or a Family Member hold any position in a public office, whether elected or employed, which will require participation in matters relating to the Association? / □ No □ Yes
(please provide detail below)
7) Do you or a Family Member have any employment or volunteer relationship with the University of Kansas or any University of Kansas affiliated entity? / □ No □ Yes
(please provide detail below)
8) Is there any other matter as to which your duty to the Association could be compromised by a competing interest? / □ No □ Yes
(please provide detail below)

Discuss details below (please reference the applicable question number)

I have read and agree to comply with all aspects of confidentiality, conflict of interest, and security expressed in this agreement or otherwise required by the KU Alumni Association. I further agree not to disclose confidential information to anyone outside of the Association at any time, either during or after my employment or Board tenure, without the prior written consent of the Association.

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DateEmployee or Board Member Signature

______

Employee or Board Member Printed Name

0411