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.