CAA(EXHIBIT) - FISCAL MANAGEMENT GOALS AND OBJECTIVES: FINANCIAL ETHICS

exhibit C

DISCLOSURE OF INTEREST FORMRELATED TOTHE HOUSTON INDEPENDENT SCHOOL DISTRICT

Name:

HISD Trustee, District:

Date Filed with Board Services:

Reporting Period:

? January 15, 2010 (for the period of July 1 through December 31, 2009)

? July 15, 2010 (for the period of January 1 through June 30, 2010)

The completion of this Disclosure of Interest form is independent of a Trustee's legal responsibility to file political contribution reports under Title 15, Election Code or to file an affidavit and abstain from further participation in the matter, including voting, when a Trustee has a substantial interest in a matter before the Board under Title 171, Local Government Code.

Did you own any interest in a business entity that had done business with the Houston Independent School District during the reporting period?

YesNo

If yes, list

Were you an officer or director of any business entity that had done business with the Houston Independent School District during the reporting period?

YesNo

If yes, list

Were you an employee or agent of any business entity that had done business with the Houston Independent School District during the reporting period?

YesNo

If yes, list

Have you done business with the Houston Independent School District during the reporting period?

YesNo

If yes, list

During the reporting period, have you received any commission, rebate, fee, or other compensation in money or property from any source as a result of business done between the Houston Independent School District and any party?

YesNo

If yes, list

During the reporting period, has any business entity in which you owned any interest received a commission, rebate, fee, or other compensation in money or property from any source as a result of business done between the Houston Independent School District and any party?

YesNo

If yes, list

During the reporting period, have you received any gift, honorarium, or other payment that was unrelated to services performed or goods furnished by you from any party who did business or who was interested in doing business with the Houston Independent School District? (You need not report food, lodging, transportation, or entertainment accepted as a guest or gifts received that have a value of less than $50 each, excluding cash or a negotiable instrument.) (Note – this item pertains to non E-Rate matters. See item 16, below for specific question covering E-Rate matters.)

YesNo

If yes, list

During the reporting period, have you done business with any professional organization, parent organization, corporation, or other group that was affiliated with the Houston Independent School District?

YesNo

If yes, list

During the reporting period, has any business entity in which you owned any interest done business with any professional organization, parent organization, or other group that was affiliated with the Houston Independent School District?

YesNo

If yes, list

Did you, or any business entity in which you owned any interest, own any bonds, warrants, notes, or other claims against the Houston Independent School District?

YesNo

If yes, list

Did you, or any entity in which you owned an interest (nonprofit or otherwise), have any business relationship involving the receipt of funds with any of the entities or individuals included on the Houston Independent School District's list of E-Rate Vendors and Related Officers/Key Employees published during the reporting period? If "yes", please respond to item 12. If "no", skip to item 14.

YesNo

If yes, list

If your response to item 11 was "yes", did you communicate details of such transactions including payer's name, date of transaction, and dollar amount to Board Services within seven business days?

YesNo

If yes, list

Did you, or any entity in which you owned an interest (nonprofit or otherwise), accept any campaign contributions from any of the entities or individuals included on the Houston Independent School District's list of E-Rate Vendors and Related Officers/Key Employees published during the reporting period? If "yes", please respond to item 14. If "no", skip to item 15.

YesNo

If yes, list

If your response to item 13 was "yes", did you communicate details of such transactions including payer's name, date of transaction, and dollar amount to Board Services within seven business days?

YesNo

If no, list

To the best of your knowledge, did you, or any entity in which you owned an interest (nonprofit or otherwise), comply with the District's "quiet period" where communications with any of the entities or individuals included on the Houston Independent School District's list of E-Rate Vendors and Related Officers/Key Employees (or potential bidder) are not allowed for a 30-day calendar period preceding a "request for proposal" until contract execution?

YesNo

If no, list

With respect to any of the entities or individuals included on the Houston Independent School District's list of E-Rate Vendors and Related Officers/Key Employees published during the reporting period, have you accepted a gift, meal, entertainment, or anything of value (excluding items of de minimis intrinsic value such as a greeting card, basic key chain, and basic pen)?

YesNo

If yes, list

Affidavit

_______________________________________ (signature)

AFFIX NOTARY SEAL ABOVE

Sworn to and subscribed before me, by the said ___________________________________, this the ____ day of ___________________, 20____, to certify which, witness my hand and seal of office.

Signature of officer administering oath

Printed name of officer administering oath

Title of officer administering oath

Definitions and Instructions for Completing Disclosure of Interest Report

In answering these, you are considered to have done business or to have had an interest if a person in the first degree by consanguinity (blood) or affinity (marriage) did business or had any interest. (These relatives include the Trustee's father, mother, father-in-law, mother-in-law, husband, wife, children, and children's spouses.)

In answering these questions, if you did any business, but used the name of a member of your family or another person instead of your own name, you should disclose the transaction.

The phrase "business entity" as used in the questions includes within its scope corporations, joint stock companies, sole proprietorships, professional associations, joint ventures, associations, and any other form of organization through which business is conducted. "Business entity" will not include a corporation whose shares are listed on national or regional stock exchanges or whose shares are traded in the over-the-counter market. "Business entity" will not include nonprofit corporations or religious, educational, and governmental institutions.

The questions are broadly stated in order to give each Trustee ample information about business interests and transactions that may be a potential conflict of interest under state law or policy BBFA(LOCAL). It is possible that in answering some of the questions, facts may be disclosed that do not relate to a violation of the law governing conflicts of interest, because in presenting questions that seek to reveal conflicts, the proper response may require that a situation not involving a conflict of interest be disclosed. You should include in your answers all facts that come within the categories about which a question is asked. This is to be done even if you believe particular acts included to be situations that do not involve a conflict of interest or that involve only a technical or a minor conflict. The inclusion of such facts is not an admission by you that a conflict of interest exists.

Where applicable, set out in detail an appropriate response to explain the nature and extent of the issue.

After a reasonable inquiry into the subject matter of the question, all questions should be answered to the best of your own personal knowledge.

"Doing business" as used in the questions will include the making of any contracts, the performance of any contracts, the selling of any products, and the performance of any services.

The Board, upon determining that correctable conflicts of interests exist, will notify the member or employee of such conflict and allow reasonable time for the correction of the conflict before taking further action.

Houston ISD

CAA(EXHIBIT)-X

LDU 2013.01

DATE ISSUED: 3/15/2013