Davie Community Foundation Scholarship Forms P.O. Box 546, Mocksville, NC 27028107 N. Salisbury Street, Mocksville, NC 27028Phone (336) 753-6903FORM A: CONFLICT OF INTEREST STATEMENTDavie Community Foundation abides by a strict conflict of interest policy, the purpose of which is to ensure that no board or committee member with a relationship to a scholarship applicant influences the decision on that application. All awards must be objectively based on stated criteria without regard to other factors not contained in the application.Committee members with a conflict may participate in the discussion, but may not vote on that application. The Committee chairman is expected to restrict or redirect the member’s participation in the discussion if there is indication of improper influence for or against the applicant.This conflict of interest standard applies to all Board members, Committee members, and other volunteers acting in a decision-making capacity on behalf of Davie Community Foundation.All committee members must sign below indicating acceptance of and adherence to this policy. Return signed form, along with other required paperwork and any printed applications, to DCF after recipients have been selected.Scholarship Fund Name: Are you(Required) Committee Member Committee Chair FORM B: SCHOLARSHIP SELECTION COMMITTEE NOMINATION FORMThe selection committee of the Scholarship Fund named above recommends to the DCF Board of Directors the award(s) listed below. Students selected for awards from the above-named fund were chosen based on criteria contained in the founding instrument. It is attested that the selection process was fair and equitable and that no voting member of the Selection Committee had or has a familial, working, or other significant relationship to any applicants for these awards. Award Recommendations:(Required) I would like to enter Selection Committee Award Recommendations At this time, the Selection Committee does not recommend awards to any currently pending applicant. Award Recommendations (click on the + sign if you will be recommending awards to more than one student)(Required)Student NameAward AmountMembers abstaining from vote, if any Add RemoveWe would like to select an Alternate(s)(Required) Yes No Alternate(s):Student NameAward AmountMembers abstaining from vote, if any Add RemovePlease also indicate one or more alternate(s) to receive the award if for any reason a recipient is unable to use the award (i.e. has already secured full funding from the institution or through federal grants, does not enroll in college, attends an ineligible institution, etc.).The Selection Committee understands that student award checks will be issued directly to the institutions with instructions to divide payments equally between terms in the upcoming academic year, with DCF staff reserving the right to reallocate awards if necessary to meet student needs.Committee Member Name: First Last Committee Chair Name: First Last Consent(Required) As Chair of the Committee, I certify that I have advised any members participating but not present of the Conflict of Interest policy, and affirm that all conflicts are disclosed on the Scholarship Selection Committee Nomination Form (Form B).Signature(Required) Untitled