disclosures: 01042cdeed57e385005a796f5b67e33f5fb2ed2a3499809b69a65d9c4c5f9be2
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| 01042cdeed57e385005a796f5b67e33f5fb2ed2a3499809b69a65d9c4c5f9be2 | 2019/Levine,_Amanda_10.18.19_-_6.pdf | 2019 | Amanda Levine | FW Parker Charter Essential School | DISCLOSURE BY NON-ELECTED STATE EMPLOYEE OF FINANCIAL INTEREST AND DETERMINATION BY APPOINTING AUTHORITY AS REQUIRED BY G. L. C. 268A, § 6 STATE EMPLOYEE INFORMATION Name: Amanda Levine Title or Position: Spanish Domain Leader and Teacher State Agency: FW Parker Charter Essential School Agency Address: 49 Antietam St., Devens, MA 01434 Office Phone: 978.772.3293 Office E-mail: mlevine@theparkerschool.org My duties require me to participate in a particular matter, and I may not participate because of a financial interest that I am disclosing here. I request a determination from my appointing authority about how I should proceed. PARTICULAR MATTER Particular matter Please describe the particular matter. E.g., a judicial or other Contract with travel company for a field trip to Mexico with students. proceeding, application, submission, request for a ruling or other determination, contract, claim, controversy, charge, accusation, arrest, decision, determination, or finding. Your required Please describe the task you are required to perform with respect to the particular matter. participation in the particular matter: I was one of the individuals who selected the travel company, Interact Travel, to contract E.g., approval, with to organize a trip with students to Mérida, Mexico, in April of 2020. disapproval, decision, recommendation, rendering advice, investigation, other. FINANCIAL INTEREST IN THE PARTICULAR MATTER Write an X by all that apply. I have a financial interest in the matter. My immediate family member has a financial interest in the matter. My business partner has a financial interest in the matter. I am an officer, director, trustee, partner or employee of a business organization, and the business organization has a financial interest in the matter. I am negotiating or have made an arrangement concerning future employment with a person or organization, and the person or organization has a financial interest in the matter. Financial interest Please explain the financial interest and include a dollar amount if you know it. in the matter As a person who will also go on this trip as a chaperone with my students, I will not pay for this trip. Cost of chaperones is included in the student price. Interact has no rewards programs for teachers, except for discounts for immediate family members to go on the trip as well. None of my family will be coming with me on this trip. Employee signature: amath Date: 61/51/01 DETERMINATION BY APPOINTING OFFICIAL APPOINTING AUTHORITY INFORMATION Name of Appointing Todd Sumner Authority: Title or Position: Principal Agency/Department: FW Parker Charter Essential School Agency Address: 49 Antietam St., Devens, MA Office Phone: 978-772-3293 Office E-mail tsumner@theparkerschool.org DETERMINATION Determination by As appointing official, as required by G.L. C. 268A, § 6, I have reviewed the particular matter and the appointing authority: financial interest identified above by a state employee. Write an X I am assigning the particular matter to another employee, or by your selection. I am assuming responsibility for the particular matter, or I have determined that the financial interest is not so substantial as to be deemed likely to affect the integrity of the services which the Commonwealth may expect from the employee. Appointing Authority signature: dlls Date: 15 OCTOBER 2019 Comment: Attach additional pages if necessary. File copy with: State Ethics Commission, One Ashburton Place, Room 619, Boston, MA 02108 Form Revised February, 2012 | 2019/Levine,_Amanda_10.18.19_-_6.pdf |