4-Mini Grant Conflict of Interest Form.docx

This is a Conflict of Interest Form for the Delaware Opioid Abatement Community Grant Program (DOSC) Mini Grant Round 4 (2026). The form requires applicants to declare whether their organization or key personnel have any actual, potential, or perceived conflicts of interest with DOSC, its staff, or committee members. Specific examples of conflicts include current or prior employment, consultancy, or advisory roles with DOSC; personal relationships with DOSC staff or committee members; and financial interests or arrangements that may directly benefit the applicant organization. Organizations must disclose all known conflicts and certify their disclosures by signature of an authorized representative, including the representative's name, title, and date of completion.

The form establishes accountability requirements by obligating applicants to notify DOSC immediately if new conflicts of interest arise during the grant period and warns that failure to disclose conflicts may result in disqualification or termination of the grant. This certification document is a mandatory component of the Mini Grant application process, which provides funding ranging from $10,000 to $30,000 to legal entities operating within Delaware. The Mini Grant program is designed to lower barriers to entry for emerging grassroots organizations and established organizations seeking supplemental resources to address the state's opioid crisis through localized interventions, with no prior operational history requirement.