New York State Standards Review Committee
Conflict of Interest Disclosure Statement
2016-2017
Check One: ELA Math
Please fill out and return with the Member Information Form.
New York State Standards Review Committee members must disclose the names of test development organizations or publishers that they have a contractual relationship with or content advisory panel on which they serve. This statement is required to ensure that the New York State Education Department does not put a member of its Standards Review Committee in a position of conflict of interest because of work that we have asked them to do.
Member Name: ___________________________________________________
I have a contractual relationship with the following test development organizations or publishers:
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I have a contractual relationship as a member of a Content Advisory Panel for the following organizations:
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Signature of member (Date)