Centre Declarations of Interest

All fields marked with * must be completed before submitting this form
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Details of the person submitting the declaration
Title
First name*
Last name*
Job title:
Organisation email*
myname@school.com
Centre number*
Centre name*
Details of conflict
Are you making a declaration about*

Staff member sitting an exam at the centreStaff member teaching or preparing their relative or close friend
Personal Information

Staff member sitting exam at their own centre*

	Candidate name	Candidate number	Qualification	Subjects	Exam series	Their position at the centre	* I confirm that I have tried to find an alternative centre but have been unable to find one	Reason an alternative centre cannot be identified
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* JCQ General Regulations state that entering members of centre staff for qualifications at their own centre must be as a last resort in cases where the member of centre staff is unable to find another centre.

Staff member teaching or preparing their relative or close friend*

	Candidate name	Candidate number	Qualification	Subjects	Exam series	Name of staff member	Their position at the centre	Relationship of staff member to the candidate	Unit number that includes internally assessed work
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Staff member teaching or preparing their child*
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