UTLA Elections

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

Start Date of Statement (required)

End Date of Statement (required)

Name of Candidate or Committee (required)

Office or Offices Being Sought (required)

Non-LAUSD Email (required)

Street Address (required)

City (required)

State (required)

Zip Code (required)

Phone Number (required)

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.

Document

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 declare the above assignment information true to the best of my knowledge. (required)
Checking this box represents your e-signature

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.

Δ