Please review the Community Music School Conflict of Interest Policy and complete this form. Include any situation, transaction or relationship in which you have been or may be involved that could constitute a potential and/or apparent conflict with the interest(s) of Community Music School. If you are uncertain whether a situation, transaction or relationship constitutes a conflict, please disclose in an abundance of caution.

Please explain Yes answer by disclosing all positions or material financial interests which you or members of your immediate family (e.g., spouse, children, parents, siblings) hold in any outside for-profit or nonprofit entity with whom Community Music School has in the past undergone, is currently undergoing, and/or may in the future undergo a business and/or financial transaction.

Please explain Yes answer by disclosing all outside positions held by you or members of your immediate family as an officer, trustee, director, or employee of a for-profit or nonprofit concern or whereby managerial or consultative service is rendered to any for-profit or nonprofit concern.

Please explain Yes answer by disclosing any other interest, relationship or affiliation of you or any member of your immediate family, including if you and/or your immediate family member(s) are currently enrolled as a CMS student or ensemble participant, which may be within the spirit (if not the letter) of the Conflict of Interest Policy, keeping in mind the purpose of this questionnaire is to protect you and Community Music School from a charge of real or apparent conflict of interest. Our goal is to avoid both impropriety and the appearance of impropriety.

I certify that the information set forth on this Annual Board of Director Individual Disclosure Statement is complete and accurate to the best of my knowledge and I acknowledge my obligation to promptly inform all other members of the Community Music School Board of Directors of any material changes and/or additions to the information set forth in this document, to answer any questions the Board may have concerning the same, to withdraw from any Board meeting while the matter remains under discussion, and to refrain from voting on the matter.

I certify that I have reviewed this disclosure statement for apparent conflict of interest issues or concerns.

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Chair, Board of Directors (Signature)

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Date

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Chair, Board of Directors (Name)