disclosures: 06b20752fb534b03410fe8629643eb2015b72b2b80eb4980fe38c40cccd2df3c
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| 06b20752fb534b03410fe8629643eb2015b72b2b80eb4980fe38c40cccd2df3c | 2018/Gabovitch,_Elaine_2.23.18_-_CM_R_5.08(4)(c).pdf | 2018 | DISCLOSURE BY PUBLIC EMPLOYEE OF AN HONORARIUM RELATED TO A LEGITIMATE SPEAKING ENGAGEMENT RECEIVED AS REQUIRED BY 930 CMR 5.08(4)(c) STATE ETHICS COMMISSION PUBLIC EMPLOYEE INFORMATION 2018 FEB 23 AM 10: 56 Your Name Elaine Gabovitch Public Title/ Position Director, Division for Children & Youth with Special Health Needs Agency Massachusetts Department of Public Health, Bureau of Family Health & Nutrition Agency Address: 250 Washington Street Boston, MA 02108 Office Phone 617-994-9815 Office E-mail Elaine.Gabovitch@state.ma.su I am disclosing that I have been invited to participate in a legitimate speaking engagement and will accept an honorarium. LEGITIMATE SPEAKING ENGAGEMENT PLEASE CONFIRM THAT YOU MEET EACH REQUIREMENT BY WRITING AN X NEXT TO IT. Write an X to confirm each The speaking engagement is a "legitimate speaking engagement" because it: statement. Is formally scheduled on the agenda of a meeting, conference or event; If you cannot check Is scheduled in advance of my arrival at the meeting, conference or event; off each statement, you cannot use this Is before an organization that normally would have outside speakers or panelists address exemption. its members at such meeting, conference or event; Significantly contributes to the meeting, conference or event. Identify the meeting, I have been invited to be the Keynote Speaker at the South Asian Autism Awareness conference or event Center's (SAAAC) inaugural conference "Culture Counts - Culturally Responsive Autism where you are Support in Research and Practices" that will take place on March 2, 2018 in speaking or attach a Scarborough, Ontario, Canada. http://saaacsummit.com/conference.html written description Note: To avoid any perceived conflict of interest, the conference promotes my keynote presentation under my role as Adjunct Instructor at UMass Medical School-Shriver Center. My biography mentions my current employment at MDPH, but does not associate the talk with my official Istate position. HONORARIUM Identify the person or organization that is Southeast Asian Autism Awareness Centre paying the honorarium Address of person or organization. SOUTH ASIAN AUTISM AWARENESS CENTRE 705 Progress Ave Unit 43-44, Scarborough, ON, Canada M1H-2X1 I 416.824.8847 I info@saaac.org Please identify the The conference is co-sponsored by several Canadian organizations: sponsor of the event Sick Kids Foundation (if different) Autism Speaks Canada AutismOntario http://saaacsummit.com/conference.html Address of the sponsor (if different) See above. Amount of the $547 includes reimbursement for my plane ticket and taxi service to and from my home honorarium and Logan Airport, as to and from the airport in Toronto and hotel, and to and from the hotel and the conference venue. It also reimburses my meal costs. SAAAC will cover hotel directly. Write an X to PLEASE CONFIRM THAT YOU MEET EACH REQUIREMENT BY WRITING AN X NEXT TO IT. confirm each statement. I certify that: Offering an honorarium is customary to the practice of the entity awarding it. If you cannot check The honorarium is being offered voluntarily, and I did not solicit it. off each statement, you may not accept Delivering the speech is not part of my official duties as a públic employee; the honorarium. I did not use resources associated with my public position in preparing the speech; I did not use public time to prepare or deliver the speech; and I have not had dealings with the sponsor of the event or the person or organization giving me the honorarium in the course of my official duties as a public employee, and do not reasonably expect to have such dealings. Employee signature Unive m. Holenitch Date 2/23/18 Attach additional pages if necessary. Elected state or county employees - file with the State Ethics Commission. Members of the General Court - file with the Senate or House Clerk or the State Ethics Commission. Elected municipal employee - file with the city or town clerk. Elected regional school committee member - file with the clerk or secretary of the committee. Judges and other judicial branch employees -- file with the Chief Justice of your court or his or her designee. Appointed or non-elected state, county or municipal employees - file with your appointing authority. Form revised April 2015 | 2018/Gabovitch,_Elaine_2.23.18_-_CM_R_5.08(4)(c).pdf |