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Financial Disclosure Statement for Calendar Year ______ (For Staff)

About this Form

Form number: 281-51

Audience:  MCPS Staff

Last revised: January 2017

Instructions:
Please complete each section and refer to the defined terms in completing your Statement. Upon completion of your financial disclosure statement, sign and date the lower portion of page two.

Additional information you should know:
Pursuant to Policy BBB, Ethics, employees are required to disclose outside employment and interests that raise conflicts of interest or potential conflicts of interest in connection with a specific proposed action by the employee or official sufficiently in advance of the action to provide adequate disclosure to the public.

This Statement is a public record and shall be made available during normal office hours for examination and copying by the public, subject to reasonable fees and administrative procedures. Any persons examining or copying such statements shall be required to record their name, home address, and the name of the person whose Statement was examined or copied. The Board of Education Ethics Panel shall review this Statement for completeness of form and for determination of any existing or potential conflict of interest. This Statement will be retained for a period of four years and then destroyed.

Adobe PDF Financial Disclosure Statement for Calendar Year ______ (For Staff)88 KEnglish

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