2026-2027 Board of Directors Contact Update and Consent Form

Each year, United Way Ozarks Region asks that all Board members renew their commitment to upholding our Code of Ethics, Conflicts of Interest Policy, and Board Member Agreement. Please complete this form to provide the UWO team with your current information and certify that you agree to our policies.

"*" indicates required fields

About You

Name*

Prefix First Last

Work Email*

Personal Email*

Home Address*

Street Address Address Line 2 City State ZIP Code

Cell Phone*

Birthday*

Month

Day

Year

Spouse/Partner First and Last Name (optional)

Child(ren) Name(s) & Age(s) (optional)

What are your hobbies and/or areas of interest? What do you do for fun?

T-Shirt Size*

Emergency Contact Name*

First Last

Relationship*

Emergency Contact Cell Phone*

About Your Work

Employer Name*

Your Title*

Work Phone

Sector*

Government

Corporate

Nonprofit

Education

Faith-Based

Other

Business Address*

Same as home address

Street Address Address Line 2 City State ZIP Code

Assistant Name

First Last

Assistant Email

Should your assistant be copied on all UWO Board emails (except confidential)?

Yes

Support of United Way Ozarks Region

Are you currently a United Way donor?*

Yes

Unsure

I need to make my gift/pledge. Please contact me.

How do you make your contribution?

Payroll deduction

Direct gift

Does your employer run a workplace campaign to support United Way Ozarks Region?

Yes

No, but they may be interested

Would you or your employer be interested in sponsoring UWO events?

Yes, I would

Yes, my employer would

Unsure

Community Involvement and Experience

Please list any boards and committees that you currently serve on, or have served on previously (business, civic, community, fraternal, political, professional, recreational, spiritual, social). Please include Organization Name, Date of Service, and Role or Title. Write n/a if not applicable.*

Have you received any awards or honors that you would like to mention?

What activities and/or committees would you like to be considered for? (Check all that apply)

Board Development Committee

Community Investment Committee

Finance Committee

Day of Caring Committee

Campaign Cabinet

Board Composition

Answers to the following questions will tell us more about our UWO Board composition as it compares to other United Way agencies across the country. We'll also use this information next year as we're recruiting new members so that we can compose a diverse and experienced board of directors.

What professional expertise/strengths do you bring to the UWO Board? (Check all that apply)*

Strategic Thinker

Connect Leaders to Leaders

Advocate for Community

Future Focused

Steward of Brand and Trust

Access to Resources & Assets

Access to Legislators

Access to Community Leaders

Access to National Influencers

Access to Content Experts

Business Operations (Finance / HR / IT / Legal)

Marketing / Public Relations

Fundraising

Event Planning

Policy/Government Relations/Advocacy

Nonprofit / Philanthropy

Entrepreneurship

Race and Ethnicity*

Please select all that apply.

American Indian or Alaskan Native

Asian

Black or African American

Hispanic or Latino or Spanish Origin of any race

Native Hawaiian or Other Pacific Islander

White

Unknown

Prefer not to say

Gender*

Age*

Code of Ethics & Conflicts of Interest

Code of Ethics*

United Way Ozarks Region

CODE OF ETHICS

All United Way Ozarks Region personnel and volunteers are expected to adhere to all laws and governmental regulations applicable to the corporation.

All staff members are expected to adhere to the ethical standards of their own profession and adhere to the provision for conduct described in the personnel policies. *

Members of the Board of Directors and all volunteers are subject to two primary obligations: **

1. Duty of Loyalty – to exercise power in the interest of the corporation not in their own interest or the interest of another entity or person and
2. Duty of Care – calls upon directors to participate in the decisions of the board and to be informed as to data relevant to such decisions.

The following are the core of ethical values, which apply to all staff and volunteers: ***

1. Honesty
2. Integrity
3. Promise-keeping
4. Fidelity
5. Fairness
6. Caring
7. Respect
8. Citizenship
9. Excellence
10. Accountability
11. Safeguard the Public Trust

* Example: Guidelines to the Standards of Professional Practice, National Society of Fund Raising Executives

** Guidebook for Directors of Nonprofits, Section of Business Law, American Bar Association

***The Josephson Institute

I certify that I have read and understand the Code of Ethics of United Way Ozarks Region and agree to comply with the Code as stated above.

Conflicts of Interest*

United Way Ozarks Region
Policy on Conflict of Interest and Disclosure of Certain Interests

This Conflict of Interest Policy is designed to help directors, officers, and employees of United Way Ozarks Region (UWO) identify situations that present potential conflicts of interest and to provide UWO with a procedure that, if observed, will allow a transaction to be treated as valid and binding even though a director, officer, or employee has or may have a conflict of interest with respect to the transaction. In the event there is an inconsistency between the requirements and the procedures prescribed herein and those in federal or state law, the law shall control.

1. Definitions
A Conflict of Interest is any circumstance described in Part 2. of this Policy.
A Responsible Person is any person serving as an officer, employee or member of the board of directors of UWO.
A Family Member is a spouse, domestic partner, parent, child, or spouse of a child, brother, sister, or spouse of a brother or sister of a Responsible Person.
A Material Financial Interest in an entity is a financial interest of any kind that, in view of all the circumstances, is substantial enough that it would, or reasonably could, affect a Responsible Person’s or Family Member’s judgment with respect to transactions to which the entity is a party. This includes all forms of compensation.
A Contract or Transaction is any agreement or relationship involving the sale or purchase of goods, services, or rights of any kind, the providing or receipt of a loan or grant, the establishment of any other type of pecuniary relationship or review of a charitable organization by UWO. The making of a gift to UWO is not a Contract or Transaction.

2. Conflict of Interest Defined

For purposes of this policy, the following circumstances shall be deemed to create Conflicts of Interest:

Outside Interests
A Contract or Transaction between UWO and a Responsible Person or Family Member.
A Contract or Transaction between UWO and an entity in which a Responsible Person or Family Member has a Material Financial Interest or of which such person is a director, officer, agent, partner, associate, trustee, personal representative, receiver, guardian, custodian, conservator, or other legal representative.

Outside Activities
A Responsible Person competing with UWO in the rendering of services or in any other Contract or Transaction with a third party.
A Responsible Person’s having a Material Financial Interest in or serving as a director, officer, employee, agent, partner, associate, trustee, personal representative, receiver, guardian, custodian, conservator, or other legal representative of, or consultant to an entity or individual that competes with UWO in the provision of services or in any other Contract or Transaction with a third party.

Gifts, Gratuities, and Entertainment
A Responsible Person accepting gifts, entertainment, or other favors from any individual or entity that: Does or is seeking business with, or is a competitor of UWO, or has received, is receiving or is seeking to receive a loan or grant, or to secure other financial commitments from UWO; is a charitable organization.
Under circumstances where it might be inferred that such action was intended to influence or possibly would influence the Responsible Person in the performance of his or her duties. This does not preclude the acceptance of items of nominal or insignificant value or entertainment of nominal or insignificant value that are not related to any particular transaction or activity of UWO.

3. Procedures

Before board or committee action on a Contract or Transaction involving a Conflict of Interest, a director or committee member having a Conflict of Interest and who is in attendance at the meeting shall disclose all facts material to the Conflict of Interest. Such disclosure shall be reflected in the minutes of the meeting.

A director or committee member who plans not to attend a meeting at which he or she has reason to believe that the board or committee will act on a matter in which the person has a Conflict of Interest shall disclose to the chair of the meeting all facts material to the Conflict of Interest. The chair shall report the disclosure at the meeting, and the disclosure shall be reflected in the minutes of the meeting.

A person who has a Conflict of Interest shall not participate in or be permitted to hear the board’s or committee’s discussion of the matter except to disclose material facts and to respond to questions. Such person shall not attempt to exert his or her personal influence with respect to the matter, either at or outside the meeting.

A person who has a Conflict of Interest with respect to a Contract of Transaction that will be voted on at a meeting shall not be counted in determining the presence of a quorum for purposes of the vote. The person having a conflict of interest may not vote on the Contract or Transaction and shall not be present in the meeting room when the vote is taken, unless the vote is by secret ballot. Such person’s ineligibility to vote shall be reflected in the minutes of the meeting. For purposes of this paragraph, a member of the board of directors of UWO has a Conflict of Interest when he or she stands for election as an officer or for re-election as a member of the board of directors.

Responsible Persons who are not members of the board of directors of UWO or who have a Conflict of Interest with respect to a Contract or Transaction that is not the subject of board or committee action, shall disclose to the Chair or the Chair’s designee any Conflict of Interest that such Responsible Person has with respect to a Contract or Transaction. Such disclosure shall be made as soon as the Conflict of Interest is known to the Responsible Person. The Responsible Person shall refrain from any action that may affect UWO’s participation in such Contract or Transaction.

In the event it is not entirely clear that a Conflict of Interest exists, the individual with the potential conflict shall disclose the circumstances to the Chair or the Chair’s designee, who shall determine whether there exists a Conflict of Interest that is subject to this policy.

4. Confidentiality

Each Responsible Person shall exercise care not to disclose confidential information acquired in connection with such status or information the disclosure of which might be adverse to the interests of UWO. Furthermore, a Responsible Person shall not disclose or use information relating to the business of UWO for the personal profit or advantage of the Responsible Person or a Family Member.

5. Review of Policy

Each new Responsible Person shall be required to review a copy of this Policy and to acknowledge in writing that he or she has done so.

Each new Responsible Person shall annually complete a disclosure form identifying any relationships, positions, or circumstances in which the Responsible Person is involved that he or she believes could contribute to a Conflict of Interest arising. Such relationships, positions, or circumstances might include service as a director of or a consultant to a not-for-profit organization, or ownership of a business that might provide goods or services to UWO. Any such information regarding business interests of a Responsible Personal or a Family Member shall be treated as confidential and shall generally be made available only to the Chair, the Executive Director, and any committee appointed to address Conflicts of Interests, except to the extent additional disclosure is necessary in connection with the implementation of this Policy.

Any changes to this policy shall be communicated immediately to all Responsible Persons.

Approved by the United Way Board of Directors
January 2007
Revised December 2008
Reviewed by Board June 2024

I hereby certify that I have reviewed and agreed to abide by the Policy of Conflict of Interest of United Way Ozarks Region that is currently in effect.

Conflicts of Interest*

Please describe any relationships, positions, or circumstances in which you are involved that you believe could contribute to a Conflict of Interest as defined in UWO's Conflict of Interest Policy outlined above.

Board Member Agreement*

United Way Ozarks Region (UWO) is a humanitarian organization dedicated to helping people and changing communities. The Board of Directors’ role is to ensure services are provided to meet our community’s needs. The Board Development Committee presented your name as a candidate to serve on the Board of Directors. We appreciate your time in reviewing the Board of Directors packet. If you agree to serve, please complete the form below.

The Board of Directors meets on the 3rd Wednesday in January, March, May, June, August, and October. You will be notified of the meeting location prior to each Board meeting. Board of Directors serve for three-year terms. The Board Development Committee may, at its discretion, also recommend a second three-year term, if the Director is willing and able to serve.

As a member of the Board of Directors:

--I accept the Bylaws and Board of Directors Position Description. I understand that I am ethically responsible for the health and vitality of United Way Ozarks Region. I also understand that, as a board member, I lead by example and will be an outstanding role model and enthusiastic community champion advocating for the United Way Ozarks Region.

--To fulfill my responsibility as a board member, I will:
• Act as an ambassador for the organization, interpreting its mission and values to the community.
• Attend at least 75% of the organization’s board meetings (in person or via Zoom). [Note: The Executive Committee can make exceptions to this requirement based on unique circumstances.]
• Make a personally meaningful financial contribution (minimum $500 Leadership Gift) on an annual basis and connect UWO to individuals and organizations that will make contributions, run campaigns, and/or establish partnerships.
• Actively participate in fundraising/resource development activities, as requested.
• Actively serve on at least one Board committee at all times.
• Act in the best interests of the organization and excuse myself from discussions or votes where I have a conflict of interest.
• Stay up-to-date regarding the status of the organization.
• Be an active, engaged participant in policy-making, discussions, and other board business.
• Work in good faith with other board members and staff members as partners toward the achievement of UWO’s goals.

--To help me with my responsibilities, the organization will:
• Send me monthly financial reports and packets summarizing recent activity before each board meeting.
• Offer me opportunities to discuss the organization’s programs, goals, activities and status with the President/CEO and Board President.
• Offer me opportunities for professional development, as recommended by the Board Development Committee.
• Respond in a forthright manner to my requests for available information that will help me carry out my duties and responsibilities as a board member

I hereby certify that I have reviewed and agreed to abide by the Board Member Agreement of United Way Ozarks Region that is currently in effect.