3-Micro Grant Conflict of Interest Form.docx

This is a Conflict of Interest Form for the Delaware Opioid Substance Abuse Commission's (DOSC) Micro Grant program under the Opioid Abatement Community Grant Program Round 4 (2026). The form requires applicant organizations and their key personnel to disclose any actual, potential, or perceived conflicts of interest with DOSC, its staff, or committee members. Specific examples of conflicts include current or prior employment or advisory roles with DOSC, personal relationships with DOSC staff or committee members, and financial interests that could directly benefit the applicant organization. Applicants must certify by signature that they have fully disclosed all known conflicts of interest and understand their obligation to notify DOSC immediately if any new conflicts arise during the grant period.

The form includes an acknowledgment and certification section requiring the signature, printed name, and title of an authorized representative along with the submission date. Applicants must understand that failure to disclose conflicts of interest may result in disqualification from the grant or termination of funding if already awarded. This disclosure requirement applies to all organizations seeking Micro Grant funding of up to $10,000 from the State of Delaware, regardless of their prior operational history or organizational structure, as part of DOSC's effort to ensure program integrity and transparent governance in the administration of opioid crisis response funding.