NAHA Annual COI and Whistleblower Statement

NATIONAL ASSOCIATION FOR HOLISTIC AROMATHERAPY

Annual Conflict of Interest and Whistleblower Policy Statement

1.       Purpose

This Annual Conflict of Interest and Whistleblower Policy Statement (this “Statement”) satisfies Section 10 of NAHA’s Conflict of Interest Policy and the training and disclosure provisions of NAHA’s Whistleblower Policy. Each Covered Person must complete, sign, and return this Statement upon first becoming a Covered Person and annually thereafter, as directed by the Secretary.

2.        Acknowledgment

By signing below, I acknowledge and affirm each of the following:

☐  I have received, read, and understood NAHA’s Conflict of Interest Policy and NAHA’s Whistleblower Policy.

☐  I agree to comply with both policies for as long as I remain a Covered Person.

☐  I understand that I must promptly disclose in writing any actual or potential conflict of interest that arises after this Statement is signed, in accordance with Section 5 of the Conflict of Interest Policy.

☐  I understand that this Statement does not, by itself, satisfy the recusal, deliberation, and approval procedures required under Sections 6 through 9 of the Conflict of Interest Policy for any specific transaction or arrangement.

3.       School Affiliation Disclosure (Conflict of Interest Policy, Section 4)

Indicate whether you are affiliated with an aromatherapy school, as defined in Section 4 of the Conflict of Interest Policy (ownership, officer or director role, employment, or instructional or curriculum-development role, whether paid or unpaid, other than an unpaid guest appearance or webinar given free of charge).

☐  I have no school affiliation to disclose.

☐  I have the following school affiliation(s) to disclose:

4.       Other Conflicts of Interest Disclosure

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NAHA Annual COI and Whistleblower Statement

Describe any other actual or potential conflict of interest under Section 3 of the Conflict of Interest Policy, including but not limited to a financial interest in a transaction under consideration by NAHA, a fiduciary or compensated role in another organization whose interests may conflict with NAHA’s (including another nonprofit organization, per Section 8), a position held in another aromatherapy organization, or an Occupancy Arrangement under Section 9.

☐  I have no other conflicts of interest to disclose.

☐  I have the following conflict(s) of interest to disclose:

 _________________________________________________________

5.       Signature

I certify that the information provided in this Statement is true, accurate, and complete to the best of my knowledge.

__________________________________________________________________________________ 

Signature

__________________________________________________________________________________ 

Printed Name

___________________________________________________________________________________

Position or Title with NAHA (e.g., Director, Officer, Committee Chair, Regional/International Director)

___________________________________________________________________________________

Date

Please return the completed Statement to NAHA’s Secretary: [email protected]. The Secretary shall retain each signed Statement in accordance with Section 10 of the Conflict of Interest Policy.

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