ALL BUDGET MANAGERS
1. Have you accepted a cash gratuity of any amount that will result in personal gain while representing North East Independent School District? Yes _____ No _____
If yes, please explain and disclose from whom____________________________________
_________________________________________________________________________
2. Have you accepted any Non-Cash gratuities that have a retail value of more than $25.00 from a vendor this year? Yes _____ No _____
If yes, please disclose who and explain__________________________________________
_________________________________________________________________________
If no, explain_______________________________________________________________
_________________________________________________________________________
4. Have you accepted lunches, dinner or other items of value from a vendor or potential vendor? Yes _____ No _____
If yes, disclose who and how much was paid by vendor _____________________________
_________________________________________________________________________
5. Do you own a business or have an interest in a company that does business with North East Independent School District? Yes _____ No _____
If yes, please disclose name of company and your interest in the outside company _______
_________________________________________________________________________
6. Does any one in your family (brother, sister, mother, father, daughter or son) work for, or have an interest in, a vendor or company doing business with North East Independent School District? Yes _____ No _____
If yes, please explain who and who they work for __________________________________
_________________________________________________________________________
_____________________________________
Signature