The City of Houston’s Housing and Community Development Department requires disclosure of any position, direct and/or indirect relationship with the City of Houston. In order to stay in compliance, all Catholic Charities employees must disclose if he/she or a family member is affiliated with the City of Houston as indicated in the survey below.

Please complete the form below as soon as possible. Thank you for your participation.

For any questions or concerns, please contact Steve Mikelman at smikelman@catholiccharities.org.

Agency Staff Conflict of Interest Form
Name
Name
First
Last
Are you or any of your immediate family member(s)*, currently or within the past year an employee, agent, consultant, officer, elected or appointed official, sub-recipient, or vendor of the City of Houston?
*Includes, whether by blood, marriage, or adoption: spouse, parent (including a stepparent), child (including a stepchild), sibling (including a step-sibling), grandparent, grandchild, and in-laws.

If YES, please indicate the names, position and/or indirect relationship with the City of Houston, and telephone numbers for each person applicable to the above question:

Person 1 Name
Person 1 Name
First
Last
Person 2 Name
Person 2 Name
First
Last
Person 3 Name
Person 3 Name
First
Last