Conflict of Interest Form

FutureQuals have a responsibility to identify, monitor and manage all conflicts of interest that relate to any person’s suitability to develop, deliver or award its qualifications.

Any person acting on behalf of FutureQuals (this includes Centre staff, delivery workforce and FutureQuals Associates) must declare any conflicts of interest that could influence their judgement, objectivity or have the potential to lead them to act contrary to FutureQuals’ or their Centre's interests in the development, delivery and award of qualifications. This could include business relationships between Centres, relationships between staff within a Centre, or across different Centres, and/or between delivery staff, learners or apprentices and Associates.

Please use this form to report a potential or actual Conflict of Interest. You can also use this form to ask us to assess whether a scenario is a Conflict of Interest or to seek guidance.

Centres must have their own Confict of Interest Policy which should be adhered to in addition to the FutureQuals policy which can be found on the website. Centres are advised to keep a log of all potential or actual Conflicts of Interest.

We may contact you to discuss any declarations and where appropriate provide guidance about how the conflict can be managed.

Centre Details *

Centre NameCentre Number

Details of the potential or actual Conflict of Interest.*

Please provide details on how the Centre is, or is proposing to mitigate the risk associated to the Conflict of Interest. What measures are in place or planning to put into place within the Centre?*

Optional - Supporting documents if relevant

Declaration:

I confirm that I have read and understood FutureQuals’ Conflict of Interest policy, including that sanctions may be incurred if I am found to be in breach of this policy.

I confirm that I understand it is my responsibility to report any new activities or Conflicts of Interest that could have the potential to lead to activities contrary to FutureQuals’ (or my Centre's) interests in the development, delivery and award of qualifications.

I declare that the information provided is a full and complete disclosure of any actual or potential conflicts of interest that may result in an adverse effect.

Name*

First NameLast Name

Role*

Email*

example@example.com

Phone Number*

Signature*

Date*

Date