Professional Conduct Disclosure Form

Starting in 2019, all nominators and nominees will be required to sign the professional conduct disclosure e-form. Depending on your role in the process, you will be required to complete one of the following two forms.  Please note that nominees will need to sign off on the e-form by the award deadline date (June 1).   Based on this, it is recommended that you submit your nomination in early so the nominee has time to review and sign.

For individuals nominating a colleague or peer: (included  as part of the nomination site)

To your knowledge has the nominated individual been the subject of a filed allegation, complaint, investigation, sanction or other legal, civil or institutional proceeding, where there was a finding of misconduct; or, are they currently the subject of such an allegation, complaint, or investigation in which their professional conduct is at issue? 

  • No
  • Yes  (If yes, you will be contacted for a confidential discussion of the details of the complaint.)

Signature - By signing this document, I certify that, to the best of my knowledge, the above response and all information provided by me related to this Professional Conduct Disclosure Form are truthful, accurate, and complete, and I agree to notify ESA promptly of any material changes required in my responses to the above question. I acknowledge the nominee’s failure to comply with ESA’s policies may result in their ineligibility to receive, or revocation of, any ESA award, honor, other type of ESA recognition, or governance position, and is grounds for potential sanctions against them.


For all nominees: (this information will be sent to you via email once you have been nominated for an award)

Have you been the subject of a filed allegation, complaint, investigation, sanction or other legal, civil or institutional proceeding, where there was a finding of misconduct; or, are you currently the subject of such an allegation, complaint, or investigation in which your professional conduct is at issue?

  • No
  • Yes  (If yes, you will be contacted for a confidential discussion of the details of the complaint).

Certification - The undersigned hereby affirms that he/she has read, understands, and agrees to comply with the ESA Code of Conduct and Ethics, and other policies and procedures established by ESA, as amended from time to time. By signing this document, I certify that, to the best of my knowledge, the above response and all information provided by me related to this Professional Conduct Disclosure Form are truthful, accurate, and complete, and I agree to notify ESA promptly of any material changes required in my responses to the above question. I acknowledge that failure to comply with ESA’s policies may result in my ineligibility to receive, or revocation of, any ESA award, honor, other type of ESA recognition, or governance position, and is grounds for potential sanctions against me.