taspa

CONFLICT OF INTEREST QUESTIONNAIRE
FORMCIQ
For vendor or other person doing businesswith local governmentalentity
This questionnaire
is beingfiled in accordancewith chapter176of the Local
Government
code by a persondoingbusinesswiththe governmentalentity.
By law this questionnaire
must be filedwith the recordsadministrator
of the
localgovernment
not laterthanthe 7th businessdayafterthe datethe person
becomesawareof facts that requirethe statementto be filed. see section
176.006,LocalGovernment
Code.
OFFICEUSEONLY
Date Received
A personcommitsan offenseif the personviolatesSection176.006,Local
Government
code. An offenseunderthis sectionis a class c misdemeanor.
1l Nameof persondoing businesswith local governmentalentity.
Dr. AlejandraMartin, ExecutiveDirector
TexasAssociationof SchoolPersonnelAdministrators(TASPA)
r
Gheckthis box if you are filing an updateto a previouslyfiled questionnaire.
(The law requiresthat you file an updatedcompletedquestionnaire
with the appropriatefilingauthoritynot laterthan
September1 of the yearfor whichan activitydescribedin Section176.006(a),
LocalGovernmentCode,is pendingand
not laterthan the 7th businessday afterthe date the originallyfiledquestionnaire
becomesincompleteor inaccurate.)
ll Describeeachaffiliationor businessrelationshipwith an employeeor contractorof the local governmentalentitywho
makes
recommendationsto a local governmentofficer of the local governmentalentity with respectto expenditureof money.
None
U Describeeach affiliationor business relationshipwith a personwho is a local government
officer and who appointsor
employsa local governmentofficer of the local governmentalentity that is the subject of this questionnaire.
None
Amended 01/13/2006
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor or other person doing businesswith local governmentarentity
FORMCIQ
Page 2
Nameoflocalgovernmentofficerwithwhomfilerhasaffiliationorbusinessrelationship.
(Completethissectiononlyifthe
answerto A, B, or G is YES.)
This section,item 5 includingsubpartsA, B, C & D, must be completedfor each officerwith whom the filer has affiliationor
businessrelationship.Attachadditionalpagesto this Form CIQ as necessary.
A. ls the localgovernmentofficernamedin this sectionreceivingor likelyto receivetaxableincomefromthe filerof the
questionnaire?
l--ly""
li-l'o
B. ls the filerof the questionnaire
receivingor likelyto receivetaxableincomefromor at the directionof the localgovernment
officernamedin this sectionAND the taxableincomeis not fromthe localgovernmental
entity?
|-l v""
lxl *o
G. ls the filerof thisquestionnaire
affiliatedwith a corporation
or otherbusinessentitythatthe localgovernmentofficerserves
as an officeror directol or holdsan ownershipof 10 percentor more?
|-l v""
lx l*o
D. Describeeach affiliationor businessrelationshio.
Describeany other affiliationor business relationshipthat might causea conflict of interest.
A m e n d e d0 l / 1 3 / 2 0 0 6