Community Full Disclosure and Conflict of Interest Survey

IN THE INTEREST OF TRANSPARENCY and BUILDING THE PUBLIC TRUST

Community Full Disclosure and Conflict of Interest Survey In the Matter of Houston Independent School District (HISD) and School Closure Proposal

Name: ____________________________________ Organization/Business ______________________________
PLEASE CIRCLE YES or NO

Do you or your organization/business have a direct financial connection with HISD? YES or NO If YES explain:

Do you or your organization/business have an indirect financial relationship with HISD? YES or NO If YES,explain:

Do you or your organization/business have a direct political relationship with local, state or national elected officials responsible for educational oversight? YES or NO If YES, explain:

Do you or your organization/business have an indirect political relationship with local, state or national elected officials responsible for educational oversight? YES or NO If YES, explain:

Do you or your organization/business have a direct relationship with local, state or national foundations and/or policy making entities involved in “school reform” including but not limited to: the Broad Foundation, The Wal-Mart Foundation, The Gates Foundation, The Arnold Foundation, and The Greater Houston Partnership? YES or NO If YES, explain:

Do you or your organization/business have an indirect relationship with local, state or national foundations, think tanks and/or policy making entities involved in “school reform” including but not limited to: the Broad Foundation, The Wal-Mart Foundation, The Gates Foundation, The Arnold Foundation, The Greater Houston Partnership? YES or NO If YES, explain:

Do you or your organization/business have a financial or political relationship directly or indirectly with Charter Schools operating locally, statewide or nationally including but not limited to KIPP Academy, YES Prep Academy, and Harmony? YES or NO If YES, explain:

Have you or your organization/business held a contract with HISD over the past 10 years? YES or NO If YES, explain:

Do you or your organization/business desire to obtain a contract with HISD? YES or NO If YES explain:

Are you or your organization/business currently or in the last 10 years been in business directly or indirectly with HISD board trustee’s? YES or NO If YES, explain:

If there are any other relationships financial, political or otherwise that impact you or your organization/business ability to be non-partial in the matter of HISD and school closure proposal please disclose below:

Signature:_________________________________ Date: __________________

Created by: The National Black United Front (NBUF) March 2014 — with Jeffrey L. Boney and 9 others. nbufhouston@gmail.com