Financial Disclosure Report Form

    If your list of donors exceeds the number of spaces on this form list the total as a single donation and itemize on a separate document, or if you'd like a PDF version instead, please contact us.

    Please review the Election Manual:

    X. Other Campaign Rules

    H. Candidates shall not seek or receive local, state or national affiliate financial support or any other form of support for his or her candidacy from vendors, UTLA staff, politicians or outside organizations and persons who stand to benefit financially or otherwise from their relationship with UTLA.

    K. Financial Reports

    Candidates for all offices, and political committees formed by candidates or in which candidates are active participants, shall, at the conclusion of the election, file one financial report with the Elections Committee on a form approved by the Committee. The report shall detail all expenditures, income and sources of income for a specific balloting in the election.report shall be due on or before 5:00 p.m. the day upon which the ballots are counted. Each candidate must sign the following affirmation “I affirm that all of the information provided by me in this form is correct to the best of my knowledge.” Financial reports pertaining to subsequent balloting shall be on file on or before 5:00 p.m. the day upon which the ballots are counted. The financial statements of candidates and committees shall be printed in summary form in the next United Teacher issue after their due date, with a notice that originals are on file for inspection. A candidate who has not filed a financial report shall not be permitted to assume the office to which that candidate has been elected unless and until the report is filed.

    UTLA ELECTIONS COMMITTEE








    Attachment

    Prefer to send a single document instead of using the form below? If so, attach your document here and skip to "I DECLARE..." section at the bottom. If not, proceed with the Income section below.



    5mb limit. DOC, DOCX, PDF, or XLS.

    Income

    I. Monetary Contributions

    • A. Itemized
      Full name of individual or committee contributor if the amount is over $50.00

      Name Amount
    • B. Non-itemized
      If the amount is $50.00 or less

      Name Amount
      Total non-itemized monetary contributions
    • Sub-total of monetary contributions: __________

    II. Non-monetary Contributions

    • A. Itemized
      Full name of individual or committee contributor if the amount is over $50.00

      Name Amount
    • B. Non-itemized
      If the amount is $50.00 or less

      Name Amount
      Total non-itemized non-monetary contributions
    • Sub-total of non-monetary contributions: __________

    III. Loans Received

    • Itemized
      Full name of individual or committee contributor/organization if the amount is over $50.00

      Name Amount
    • Sub-total of loans: __________

    Expenses

    • Income Amount
      Telephone
      Mailings (postage, office supplies, etc.)
      Receptions (food, paper goods, entertainment, etc.)
      Misc. Office and Meeting Supplies Not Reported
      Food for Volunteers
      Estimate of Bills Not Received
      Website or Other Media
      Room or Equipment Rentals
      Mileage to Visit Schools
      Loans Repaid
      Other (please specify)

    Totals

    • Total Income __________
      Total Expenses __________


    I, __________, affirm under penalty of perjury that all of the information provided by me in this form is correct to the best of my knowledge.

    __________
    Signature of Candidate

    __________
    Date Signed

    This form goes to Tara Thomas of the UTLA Elections Committee, who can also be reached at tthomas@utla.net or 3303 Wilshire Blvd., 10th floor, Los Angeles, CA 90010 or 1–213–637–5165.

    As a result of the COVID-19 pandemic, there are changes to the election process that have been put in place for the safety and welfare of our members. The UTLA building is closed. Meetings will be held virtually. Communication will be through email. All forms, statements, etc. will be submitted through this website.