disclosures: 0598c3e8b5703e0557e55083c05ea39ffa9b27e0c1d19bfac42ad6aeef50b104
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| 0598c3e8b5703e0557e55083c05ea39ffa9b27e0c1d19bfac42ad6aeef50b104 | 2017/Haque,_Sheila_6.26.17_-_6.pdf | 2017 | Sheela Haque | DISCLOSURE BY NON-ELECTED STATE EMPLOYEE OF FINANCIAL INTEREST AND DETERMINATION BY APPOINTING AUTHORITY AS REQUIRED BY G. L. C. 268A, § 6T ATE ETHICS RECEIVED COMMISSION STATE EMPLOYEE INFORMATION 2017 26 AM11:56 Name: Sheela Haque Title or Position: Rural Counselor and Educator State Agency: University of Massachusetts - Amherst Center for Women and Community Agency Address: 180 Infirmary Way New Africa House Amherst, MA 01003 Office Phone: 413-658-4756 Office E-mail: shaque@umass.edu This disclosure relates to a class of matters, described below, that I anticipate may arise as a result of my prospective employment for a non-profit organization, It Takes A Village (ITAV), serving individuals who are likely to be eligible for different services provided by or through the Center for Women and Community (CWC). Accordingly, my CWC duties would ordinarily require me to participate in a particular matter, such as the referral of a CWC client to ITAV, that 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 I will be starting employment with It Takes a Village (ITAV), which is an organization based in the proceeding, application, Hilltowns of Western Massachusetts. ITAV has 3 main programs: 1. A home visiting program for submission, request postpartum families during the first year postpartum; 2. The Closet, a destination site where free for a ruling or other baby and maternity gear is distributed; and 3. A Mothers' Postpartum Support Group in the Northern determination, contract, Hilltowns. claim, controversy, charge, accusation, arrest, decision, My current position with CWC, a state agency within UMass, involves the provision of counseling determination, or finding. and advocacy for survivors of sexual violence and domestic violence in the Hilltowns of Western Massachusetts. I also engage in prevention work, outreach, education, and community building through participation in local coalitions. The particular matters I foresee are referrals of CWC clients to ITAV. Your required Please describe the task you are required to perform with respect to the particular matter. participation in the particular matter: I anticipate that particular matters within the scope of $ 6 will arise as follows: There may be times when a CWC client needs services from ITAV and it would ordinarily be professionally necessary E.g., approval, and appropriate for me in performing my CWC duties to refer the client to ITAV. (The inverse — a disapproval, decision, recommendation, referral of an ITAV client to CWC - is also likely to occur, but it is my understanding that § 6 does rendering advice, not apply to these matters). 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 will be an 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 Assuming that ITAV is a "business organization", it will have a non-quantifiable financial interest (positively and negatively) in my decision whether or not to refer a CWC client to ITAV. The positive financial interest lies in the fact that ITAV is funded by private grants and as such, it benefits from referrals of clients by increasing the numbers of people served, which then can be used to apply for future funding or to satisfy goals associated with current funding. The negative financial interest arises because any services ITAV provides are free of charge to the referred client and therefore the cost of service is borne solely by ITAV. I note that my compensation from ITAV is a fixed amount unrelated to the volume of services it provides (either from CWC referrals or any other source). In addition, it is not contemplated that my duties for ITAV will include the provision of direct services to particular clients referred from CWC. Employee signature: Sheela Haque SA Date: May 1, 2017 6/14/17 DETERMINATION BY APPOINTING OFFICIAL APPOINTING AUTHORITY INFORMATION Name of Appointing Authority: Rebecca Lockwood Title or Position: Associate Director Agency/Department: University of Massachusetts - Amherst Center for Women and Community Agency Address: 180 Infirmary Way New Africa House Amherst, MA 01003 Office Phone: 413-545-5832 Office E-mail rlockwood@umass.edu 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-Commenwealth may expect from the employee. Appointing Authority signature: Date: 6/14/17 Comment (optional): | 2017/Haque,_Sheila_6.26.17_-_6.pdf |