Find it fast Open

GBEBC-FRM1

DISCLOSURE BY A PUBLIC EMPLOYEE OF A GIFT, BENEFIT OR ITEM OF SUBSTANTIAL VALUE AS REQUIRED BY G.L. c. 268A, § 23(b)(3) and 930 C.M.R. § 5.04(3)

PDF Icon

DISCLOSURE BY A PUBLIC EMPLOYEE OF A GIFT, BENEFIT OR ITEM  OF SUBSTANTIAL VALUE AS REQUIRED BY G.L. c. 268A, § 23(b)(3) and  930 C.M.R. § 5.04(3)  

Any employee who has received gift given as a result of their position with the  Hopkinton Public Schools and with a fair market value of between $10 and $49 must  complete this form and submit to his/her supervisor.  

This is a computer-fillable form. The text box area will expand as you type. When  complete, print it out, sign and date it, and provide to your supervisor. 

Name

 

Title or Position

 

School or 

Department

 

What is/are the  

gift(s)?  

Describe each  

briefly. 

 

What is the actual  or estimated fair  

market value of the  gift? 

 

Who is/are the  

donor(s)? (Provide  full name(s).) 

 

Why was the gift  given? (Example:  Holiday, End of  

School Year)

 

What is the  

donor’s interest in  your performance  of official duties?  (Example: parent  

of child I teach) 

 

Signature

 

Date

 


 

Policy Name Revised 5.29.2019

School Committee Policies