Conflict of Interest Disclosure Statement Updated on: October 1, 2023(Complies with Operational Guide PP5) FY 2023-2024 This form to be completed annually, in accordance with the Austin College Conflict of Interest Policy and the definitions set forth therein. 1. Are you aware of any relationships between AUSTIN COLLEGE, its service partners, vendors or suppliers and yourself or a member of your Family as defined by the letter or spirit of AUSTIN COLLEGE’S Conflict of Interest Policy that may represent a conflict of interest?* No Yes If yes, please list such relationships and the details of annual or potential financial benefit as you can best estimate them.2. During the past 12 months, did you or a member of your Family receive any gifts or loans from any source from which AUSTIN COLLEGE buys goods or services or otherwise has significant business dealings?* No Yes If yes, please list them, their source, and their approximate value.3. Do you or a member of your Family hold any investments, as defined by the letter or spirit of this policy that may represent a conflict of interest?* No Yes If yes, please list such investments and the details of annual or potential financial benefit as you can best estimate them.4. Other Disclosures of Actual or Potential Conflicts of Interest: (If there are none, please indicate so.)* None Yes If yes, please provide information.AcknowledgementI certify that I have read and understand AUSTIN COLLEGE’S PP 5 Conflict of Interest Policy - All Others and that the foregoing information is true and complete to the best of my knowledge. I further acknowledge and agree that I have a continuing obligation to update this disclosure form, should an actual or potential conflict of interest arise. Name* Email*