STUDENT AND CAMPUS ACTIVITY FUND MANUAL · STUDENT AND CAMPUS ACTIVITY FUND MANUAL ... (ex....

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PO BOX 220, LYFORD, TX 78569 BUSINESS OFFICE PH NO. 956.347.3901 BUSINESS OFFICE FX NO. 956.347.3921 1 | PAGE LCISD 2016 STUDENT AND CAMPUS ACTIVITY FUND MANUAL PREFACE This manual is designed to provide a set of standardized accounting guidelines and procedures for the administration of the Lyford Consolidated Independent School District Activity Funds. Principals, secretaries, clerks, sponsors, and other personnel involved in the handling of activity funds are responsible for adherence of the guidelines and procedures prescribed in this manual. The procedures outlined herein comply with statutory requirements and constitute policy as established by the Board of Trustees of the Lyford Consolidated Independent School District. (LCISD Policy CFD Local). This manual replaces all prior publications regulating the administration of activity funds including all earlier editions of the manual itself.

Transcript of STUDENT AND CAMPUS ACTIVITY FUND MANUAL · STUDENT AND CAMPUS ACTIVITY FUND MANUAL ... (ex....

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STUDENT AND CAMPUS ACTIVITY FUND MANUAL

PREFACE

This manual is designed to provide a set of standardized accounting guidelines and procedures for the administration of the Lyford Consolidated Independent School District Activity Funds.

Principals, secretaries, clerks, sponsors, and other personnel involved in the handling of activity funds are responsible for adherence of the guidelines and procedures prescribed in this manual.

The procedures outlined herein comply with statutory requirements and constitute policy as established by the Board of Trustees of the Lyford Consolidated Independent School District. (LCISD Policy CFD Local).

This manual replaces all prior publications regulating the administration of activity funds including all earlier editions of the manual itself.

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TABLE OF CONTENTS I. SECTION -GENERAL INFORMATION

A. PURPOSE OF ACTIVITY FUNDS B. FACULTY/PRINCIPALS FUNDS C. STUDENT ACTIVITY FUNDS D. RESPONSIBILITY FOR ACTIVITY FUNDS E. FUNDRAISERS F. RETENTION OF RECORDS

II. SECTION -BASIC RECORDS A. ACTIVITY FUND CASH RECEIPT VOUCHER B. ACTIVITY FUND PURCHASE ORDER C. ACTIVITY FUND PAYMENT VOUCHER D. PRE-NUMBERED CHECKS E. BANK DEPOSITS F. MONTHLY BANK STATEMENTS G. PREPARATION OF RECORDS

III. SECTION-BANKING PRACTICES AND PROCEDURES A. BANK ACCOUNTS B. CHECK SIGNATURES C. ACTIVITY ACCOUNT RECONCILIATION

IV. SECTION-OTHER ISSUES A. CONFLICT OF INTEREST B. INVESTING CAMPUS AND STUDENT ACTIVITY FUNDS C. FIXED ASSETS D. PARENT ORGANIZATIONS E. PAYMENTS TO NON-EMPLOYEES FOR CONTRACTED F. YEARBOOKS G. PICTURE SALES

LOCAL POLICIES

FORMS

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SECTION I -GENERAL INFORMATION

A. PURPOSE OF ACTIVITY FUNDS

The activity fund is designed to account for funds held by a campus in a trustee capacity or as an agent for students, club organizations of campus, teachers and the general administration of the campus. These funds are used to promote the general welfare of each campus and the educational curriculum of the District. The accounting function for the activity fund is delegated to each campus and must comply with the guidelines and procedures required by this manual.

All funds raised by student organizations must be expended for the benefit of the students. Carryover funds shall be left in the appropriate account and each sponsoring group shall retain the carryover funds for the next fiscal year. If an organization ceases to function or exist, the unexpended funds of the organization shall be credited to the appropriate administrative activity account. Adequate measures to control these funds will assure parents and students that the funds are handled properly.

The activity fund consists of two different funds: Faculty/Principal Fund and Student Activity Funds.

B. FACULTY/PRINCIPAL FUND

Faculty/Principals Fund consists of funds raised by staff at a particular campus which is managed by the principal/assistant principal or an administrator. Principals may use these funds to supplement their budgeted district funds. These funds should not be spent to benefit any individual or non-student group.

The following expenditures are strictly prohibited under the Faculty/Principals Fund:

1. Instructional supplies 2. Office supplies 3. Office equipment 4. Appliances & furniture for lounge (ex. Refrigerator, toaster, coffee maker) 5. Teachers in-service fees & staff development expenses 6. Flowers for death, illness, or leave of absence 7. Meals or expenses relating to a Parent Teacher Association or Organization 8. Stipends and monetary awards to employees

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9. Payment of district mileage to school employees 10. Gift card

The following expenditures are allowable expenditures under the Faculty/Principals Fund:

1. Awards such as plaques in recognition of staff or volunteers for service to the school and/or district and related reception expenditures (ex. teacher’s appreciation week, counselor’s week, nurse’s week, librarian’s week)

2. Food only for staff meetings or holiday celebrations (ex. cups, napkins, paper plates). If food is purchased from an individual vendor, the vendor must provide his/her food safety certification. The food safety certificate must be attached to the purchase order. Expenditures should not exceed the limits established by the district’s travel reimbursement procedures.

3. Out-of-town meals, lodging and travel expenditures for faculty/staff members who must accompany students provided that expenditures do not exceed the reimbursable limits established by the district’s travel reimbursement procedures (Any travel disbursement must be documented by an LCISD travel payment request form and reconciliation.)

4. Field trip fees and/or meal fees for staff and other activities planned for the benefit of students, either as recognition of an accomplishment or for purposes of enrichment.

This list is not intended to be all inclusive. Principals and administrators should use their own discretion and be guided by the principles addressed in this manual.

All purchases made with the Faculty/Principal Fund need to be with Lyford CISD Student Activity Accounts approved vendors.

C. STUDENT ACTIVITY FUNDS

Student activity funds consist of money received and held by campus in a trustee capacity or as an agent for students, club organization of the campus, teachers and general administration of the campus. Student activity funds are accounted for by the district as agency funds in compliance with the TEA Financial Accountability System Resource Guide. The basic purpose for the collecting or raising and expending of activity funds must be for the direct benefit of the students or for the general benefit of the school. Within this scope, funds are to be used to finance activities which supplement the educational curriculum of the District. Fund raising activities shall in general contribute to the educational experience of pupils and shall not conflict with the instructional program. Student participation is an important factor in the management of money raised by the

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student body and expended for its benefit. All expenditures should be approved by the membership of the student organization. Student activity funds consist of Student Class and/or Club Accounts.

Student Class and/or Club Accounts are raised by individual student groups, and their disbursement is controlled by that group.

The following expenditures are strictly prohibited under the Student Activity Fund:

1. Expenditures not approved by Principal and Sponsor (not stated in Fundraiser Application Form) 2. Any purchase other than those listed below which benefits adult sponsors and does not

benefit student members 3. Equipment and/or furniture 4. Gift cards

The following expenditures are allowable expenditures under the Student Activity Fund:

1. Expenditures approved by the Principal and Sponsor as stated on the Fundraiser Application Form (ex. Club supplies, field trips, etc.)

2. Incentives that target all student club/class members 3. Entry fees and other expenses associated with competition and meetings 4. Travel expenses and meals consumed by the student members only (Travel disbursements must

be documented by an LCISD travel payment request form and reconciliation.) Expenditures should not exceed the limits established by the district’s travel reimbursement procedures.

5. Membership in related organizations

All purchases made with the Student Activity need to be with Lyford CISD Student Activity Accounts approved vendors.

RESPONSIBILITY FOR ACTIVITY FUNDS

All campus personnel including principals, bookkeepers, secretaries, and faculty will be held responsible for any campus and student activity funds entrusted to them. Money (or property purchased with campus or student activity money) which is lost due to carelessness, theft, or fraud will be reimbursed by the responsible party.

Principals/Campus Administrator’s Responsibility

The principal/campus administrator is responsible for the overall administration of the Student Activity and the Campus Accounts including bookkeeping, monthly reporting and compliance with

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the policies and procedures manual. The principal will approve all fund raising activities in advance and will monitor the activities by reviewing and signing the Fund Raiser Report. It is the principal’s obligation to see that all faculty sponsors have signed the Responsibilities of Faculty Sponsors of Student Groups and the Conflict of Interest Form before the designated sponsor undertakes the Student Activity Account and that these forms are kept on file. The principal shall review the STUDENT AND CAMPUS ACTIVITY FUND MANUAL along with the designated sponsor before undertaking the Student Activity Account and ensure that the sponsor fully understands the guidelines and procedures presented in this manual.

Activity Account Sponsor’s Responsibility

The Activity Account Sponsor’s Responsibility is responsible for safeguarding and accounting for all student activity funds entrusted to him (or her). It is the obligation of the sponsor to follow the procedures presented in this manual. This includes maintaining a positive balance in his (or her) account at all times and completing the Fund Raiser Report to approve/account and monitor all fundraising activities in advance by the principal/campus administrator, Special Activity Form to get approved to have fundraising activities by the principal and superintendent, Purchase Order used to document authorization to order services or items, Payment Voucher used to document authorization to issue payment, Cash Receipt Voucher to record all monies collected and deposit given to the student activity account clerk by the sponsor, Sales Tax Report used to report sales tax collection, Request for Acceptance of Donated Items Form used to accept donations received by the district and must be approved by the Board of Trustees and including all attachments accordingly before it is provided to the Activity Accounts Clerk. The faculty sponsor will sign the form titled Responsibilities of Faculty Sponsors of Student Groups and the Conflict of Interest Form before undertaking any sponsorship of a student club or organization. The forms will be filed at each campus.

Business Office Manager’s Responsibility

The business office manager is responsible for monitoring the monthly activity and bank reconciliation for all campuses and central office accounts. The business manager will advise the principal of situations where sponsors continue to disregard required procedures. The business office will work with the campus staff to correct any deviations from the requirements of the policy and procedures manual and will inform the principal in the event that such deviations cannot be resolved.

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Activity Accounts Clerk (or other designated employee) Responsibility

The activity accounts clerk (or other designated employee) is responsible for the following:

1. Maintaining the accounting records as required in the policies and procedures manual 2. Completing monthly bank statements and activity reports 3. Issuing checks when properly authorized by the principal, business manager and superintendent 4. Receiving deposits and making entries to the school accounting software and 5. Depositing into the school’s bank account.

D. FUNDRAISERS

Each student or campus club, as approved by the principal, will be allowed to conduct a maximum of two tax free fundraisers in each CALENDAR year. The Principal shall approve any additional fundraisers under certain circumstances. Each principal will control the number and kinds of fund raisers allowed on his (or her) campus.

What is considered a fundraiser?

Selling of goods, charging admission to student events, collection of donations, any means your organization uses to collect funds. If an organization plans on doing any of these activities or others not mentioned for the purposes of generating funds, the group must follow the fundraising policy.

When should the fundraiser request be submitted for approval?

The fundraiser request form needs to be submitted at least three weeks prior to the actual event to the Principal for approval. Before the organization decides to fundraise, please make note of the following limitations to on campus fundraising:

1. All fundraisers involving food should follow school wellness policy and must pass the nutrition calculator tool (accordingly), as explained and noted on the Fundraiser Report.

a. Faculty/Teacher food fundraisers are exempt from the school wellness policy and nutrition calculator tool (revised 09/14/2016).

2. Permissions shall not be granted for products and services that conflict with the mission and standard of SFE set forth by school wellness policy.

3. Items sold for this purpose should encourage “healthy” habits and reinforce the positive nutrition message.

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4. No fundraisers will be initiated without the written authorization of the principal or administrator designated.

In order to establish control over the funds raised by student and other groups all sponsors are required to complete a Fund Raiser Report for each fundraising project. Although the report itself is the obligation of the faculty sponsor, the Principal is responsible for enforcing compliance with this requirement.

The Fundraiser Report

The Fund Raiser Report will be used both to authorize and document fundraising activities. Before beginning any such activity, the faculty sponsor will complete the Request for Fundraiser section of the report which describes the type and purpose of the fundraising project. The principal or administrator designated will sign the request to document approval. The report will then be returned to the faculty sponsor.

Accounting for the Fundraiser

Sponsors who are involved in fundraising activities have an obligation to account for all of the funds which are collected (or should have been collected). The Fundraiser Report provides a record of receipts and disbursements associated with a fundraiser. In the event that the sponsor is later questioned about the amount of money raised, the Fundraiser Report will document the amount of cash received and that it was properly deposited. Related expenditures are also included on the report.

The sponsor will complete the Activity Report within ten (10) school days of the conclusion of the fundraising event. The number and selling price of the items sold are entered to determine the gross profit. All of the expenses incurred in the fundraiser will be documented on the report. Checks will be entered individually. If more room is necessary, the sponsor will use the back of the report or an additional sheet. No cash expenses will be allowed from daily fundraiser collections.

In some cases when merchandise is given to students to sell, the sponsor is unable to recover either the merchandise or the money. This is considered an expense of the project and will be entered in this section of the report. A list of students who did not pay must be attached to the report.

Enter the net profit on the Fundraiser Report. The net profit of the activity is the gross profit less the expenses. All funds collected (less expense paid in cash) must be turned over to the Principal. Enter

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the number and amount of each deposit on the report. The completed form is to be attached to the Cash Receipt Voucher when the deposit is made.

Some activities involve a long collection process. The sponsor may collect small amounts from students over several months and deposit these with the activity account clerk. In this case it is recommended that the sponsor keeps a log of amounts collected and deposited for each project. Rather than copy all of the amounts and receipt numbers on the Fundraiser Report, the sponsor may attach a copy of a log to the report.

After completing the Fund Raiser Report, the sponsor will sign it and submit it to the Principal or administrator designated for review. Reports which are incomplete or which are incorrect should be returned to the sponsor. This report should be used by the Principals to evaluate the success of the fundraising activities and the ability of the sponsor to account for money raised. It should guide the Principal’s decisions concerning the approval of future projects. Once the report has been signed by the principal, it will be filed with the other accounting records of the student group.

The sponsor will keep a copy for his/her files. Note: It is the responsibility of the sponsor to account for the fundraiser. Activity Reports will not be completed by the activity account clerk.

Cash collected from fundraiser:

In-district: Cash/Checks received must be locked at the end of the day in campus vault/safe by campus administrator.

Out-of-district: Sponsor is responsible for safekeeping of cash/checks in a lock location until next school day, where at that time cash/checks must be locked in the campus vault/safe.

Raffles:

The district is not a “qualified nonprofit organization” for purpose of Charitable Raffle Enabling Act and shall not sponsor or conduct raffles (ex. Award one or more prizes by chance at a single occasion among a pool or group of persons who have paid or promised a thing of value for a ticket that represents a chance to win a prize. Occupations Code 2002.001 et seq.; Atty. Gen. Op. JM-1176 (1990) [See also GKB] Policy FJ (Legal).

Special Activity Form

The Special Activity Form is required to be filled out by the sponsor and submitted to the Principal and Superintendent for approval of all fundraising activities. This form is used to verify that the fund

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raising activity is in compliance with state and federal law. Such activities that are not allowable are activities associated with gambling such as any form of raffles. These types of fundraising can only be done through a 501c3 non-profit entity which Lyford CISD is not considered under the I.R.S. regulations. The approved form must be attached to the purchase order when an order or service is being requested in relations to the special activity.

Sales Tax

Public schools are exempt from paying the state sales and use tax. Therefore, public schools do not pay sales tax on items purchased for their own use. However, exemption from paying sales tax does not relieve public schools from the obligation to collect sales tax on taxable sales. In most cases when a school or school organization sells items to individuals which become the property of the individual, sales tax must be collected. Some items are specifically exempt from sales tax and there are some cases when sales which would ordinarily be taxable are exempt. These are discussed in more detail below.

The following description of taxable and nontaxable sales is adapted from the TEA Financial Accountability System On-Line Resource Guide.

Public schools and school-related organizations must collect sales tax on all sales which are not specifically exempt. For example, sales tax must be collected on the following:

• School purchased supplies sold directly to students including athletic equipment, uniforms, band supplies, t-shirts, jackets, and school supplies

• Fees for materials when the end product becomes a possession of the student

• Student publications such as yearbooks and football programs

• Articles such as pencils, cups, etc. with the school logo which are sold during fund raisers

• Books sold to students at book fairs

Remember that the items listed above are presented for purposes of illustration. The list is not intended to be all inclusive.

Public schools and school-related organizations are NOT required to collect sales tax on the following:

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• Admission tickets, if the event is entirely for educational purposes. This includes sporting events and drama or musical performances by students. (An educational purpose exists when 100% of the proceeds from admissions go to an educational organization.)

• Student club memberships

• Sales of food and soft drinks that are:

• sold or served during the regular school day

• sold or served by a parent-teacher association during a fund-raising sale, the proceeds of which do not benefit an individual

• sold by a person under 18 years of age who is a member of an organization devoted to the exclusive purpose of education, and groups associated with public elementary or secondary schools as a part of a fund-raising drive sponsored by the organization for its exclusive use.

• Newspapers whose sales price per copy does not exceed $ .75; that are printed and distributed periodically at intervals of four weeks or less; for the dissemination of news of a general character and of a general interest. Of course, school newspapers which are not sold are not subject to sales tax.

One-Day Tax-Free Sales

Each school in the District, each organization within that school, and each outside organization affiliated with that school are allowed to have two one-day tax-free sales during a calendar year.

One-day tax-free sales mean that collection and remittance of state sales taxes is not required on qualified sales on that day. The delivery of yearbooks to students on a single day qualifies a yearbook sale as a one-day tax-free sale even though the yearbooks were sold over a longer period.

This rule can be applied to other fund raisers when the delivery is made to the students on a single day. Note that the time limit for the two (2) one-day tax-free sales is a calendar year which is from January 1 through December 31, rather than a school year.

While the sale of yearbooks can be selected as one of the two one-day tax-free fund-raisers, a book fair is usually not a qualified tax-free event because the school is not the actual seller. The school is acting as an agent for the vendor. The sale of items received from a vendor, in which the school and

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the respective vendor have an agreement that the vendor will take back any unsold items, would generally not qualify as a tax-free sale because the vendor is not an exempt organization.

The tax-free status of a one-day tax-free fund raiser must be so designated on the Fund Raiser Report and approved in advance by the Principal.

Collecting Sales Tax

Schools and school organizations must collect sales tax (currently 8.25%) on all taxable items. There are two ways to collect sales tax:

• The tax can be added to the selling price of an item. For example, if the selling price is $1.00, the school would collect $1.09 for each item sold. (ROUNDED)

• The tax can be included in the selling price. For example, if an item is sold for $1.00, including tax, the school would retain $ .90 and the remaining $ .0825 would be remitted as sales tax. (To “back out” the amount of the sale, divide the selling price by 1.0825. The sales tax is the difference between the amount of the sale and the selling price.) (ROUNDED)

Reporting Sales Tax

Each organization, class or club which sells merchandise must report its sales once the sale is concluded. The Sales Tax Report should be completed and turned into the activity accounts clerk with the cash receipt voucher. The total sales, taxable and nontaxable, are reported on this form. Nontaxable sales and one-day tax-free sales are deducted from total sales to arrive at net taxable sales. If there is a sales tax liability, the activity account clerk will charge the appropriate organization when the check for sales tax is written.

The activity account clerk will charge each campus organization for its share of the sales tax. Copies of the sales tax reports completed by each organization reporting sales will be attached to the report. The Business Manager will report taxable and nontaxable sales and remit the sales tax due to the State Comptroller’s Office.

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F. RETENTION OF RECORDS

Record Retention

Principals, sponsors, secretaries and activity accounts clerks are required to keep all documentation of a fundraiser for five years. These records should be kept neatly with the Fundraiser Report and be readily available for examination by the Principal, the External Auditor, or the Business Manager

If any sponsor, secretaries or student activity clerk that leaves the campus or do not have these responsibilities for the subsequent year, they should turn any and all pertinent documents over to the Principal.

II. SECTION -BASIC RECORDS

This chapter describes the procedures to be followed to maintain adequate accounting records for both the Student Activity and Campus Accounts. The records described in this chapter will be maintained by the principal, sponsor and activity accounts clerk. They must be kept current and available for review by the Principal, the Business Manager, and the External Auditor.

Receiving Cash

In order to maintain control over cash received, at least two persons must be involved in the functions of collecting, documenting, depositing cash and reconciling the bank statement. This is accomplished by having teachers or sponsors collect from the students, support the amount collected by completing the Cash Receipt Voucher and other supporting documentation described below, and submit the cash to the activity account clerk for receipt and deposit. An activity account clerk cannot accept cash that has not been counted and that is not properly supported by a completed Cash Receipt Voucher.

Receipt of Money by the Activity Account Clerk

The following procedures shall be followed by the activity account clerk when funds are received for deposit into the school’s bank account:

1. The activity account clerk will count the money to ensure agreement with the Cash Receipts Voucher. Whenever possible this will be done in the presence of the person turning in the funds. The activity account clerk will reconcile the amount received with the Cash Receipts Voucher.

2. The activity account clerk will initial, write the date and the amount on the Cash Receipt Voucher and return it to the sponsor.

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3. The sponsor must request the driver's license number on all checks received for deposit. The checks will be immediately endorsed with the statement “For Deposit Only” and the account number. The activity account clerk will check to see that the activity account number is written in the upper left-hand corner of the check.

A. ACTIVITY FUND CASH RECEIPT VOUCHER

Cash receipts journals are used to record all receipts of cash/checks. Deposits must be entered in a cash receipts journal to record the amount, date of the deposit, and receipt number. Other entries which may be made to the cash receipts journal are corrections of errors, re-deposits, and interest paid by the bank.

Cash Receipt Deposit Process

1. Deposits can be made Monday-Thursday during the business hours of 7:30am-12:00pm and 1:00pm-4:30pm and Friday during the hours of 7:30am-12:00pm and 1:00pm-2:30pm.

2. The Campus Administrator must be present to make deposits. If the Campus Administrator is unable to be present at the time the deposit is being made, the Campus Administrator shall make arrangements to come no later than the next business day. Future deposits would not be accepted until prior deposit is completed.

3. Complete a Cash Receipt Voucher for funds you wish to deposit.

4. Complete a deposit slip and make sure all checks are stamped and that all personal checks have a valid driver’s license number. Checks without driver’s license numbers will not be accepted.

5. Attach copies of all checks to the Cash Receipt Voucher.

6. Attach the completed Sales Tax Report for all fundraisers, as well the approved Fundraiser Report and attach it to the Cash Receipt Voucher.

7. Complete a Request for Acceptance of Donation Items Form for all donations and attach it to the Cash Receipt Voucher.

8. Attach the yellow carbon copy of all receipts (from your organization’s receipt book) that correspond to the funds deposited.

Incomplete funds deposits will not be accepted.

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The following information must be indicated on the bank deposit slip:

1. The date and the amount of the deposit.

2. A list of each check in the deposit showing the maker’s name and amount.

3. The activity account number.

Whenever possible debit and credit memos received from the bank for deposit shortages and overages will be traced to the appropriate account. An adjustment will be made to the activity account in the Journal as either an additional receipt or disbursement.

Returned Checks

A check which has been deposited may be returned unpaid by the bank for a variety of reasons. The following procedures will be required to account for returned checks:

1. The activity account clerk will determine which activity account originally collected the check.

2. The activity account clerk will collect for the returned check plus a $20.00 fee will be added on the return check activity account.

3. If the activity account clerk or designated employee is not successful, a copy of the check will be sent to the district attorney’s office for collection.

4. The returned check fee has been established at $20.00 per check. The sponsor shall be responsible for collecting this fee along with the amount of the check, if the check writer was not reachable.

5. When the cash is collected by the sponsor or designated employee in charge of collection, the original check will be released to the sponsor to be returned to the check writer.

6. On the cash receipts journal, the amount of the redeposit will be entered as a deposit, with a notation identifying it as a redeposit and indicating the check writer.

B. ACTIVITY FUND PURCHASE ORDER

Activity Accounts Purchase Orders are among the most commonly utilized method for procuring goods and services. As its name indicates, this document serves as a formal order for goods, materials and/or services from a vendor. A purchase order, once approved by the campus administrator, business office

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manager and superintendent, is a binding commitment for a district to remit payment to the vendor after the item(s) and an original invoice are received by the district.

A purchase order is also an important accounting document. It contains information on the expenditure to be made and the account code to be charged. Once issued, the purchase order encumbered funds will serve as an expenditure control mechanism. Finally, the purchase order is utilized in the activity accounts payable process as it documents that an order has been received and accepted by the user and payment process can begin to be made to the vendor.

Purchase Order Process

A purchase order should be of a standard format to facilitate processing and should contain the following items:

• Vendor name and address

• Quantity of goods

• Description of goods

• Account codes

• Price (per unit and in total)

• Payment terms

• Discounts, if any

• Any special instructions must be included on requisition (i.e. check processing information, check disbursement information, forms to be included with checks, etc.)

• Freight or service charges

• Transportation arrangements

• Other pertinent factors such as delivery destination

As indicated earlier, purchase orders starts as a requisition which is prepared manually. The purchase order originates with the user or user department and describes the item to be purchased, the quantity,

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pricing, the account to be charged, and vendor. Purchase orders have multiple copies which includes a (n):

• Vendor Copy-(White Copy) which is sent to the selected vendor by the sponsor

• Activity Account Clerk Copy-(Yellow Copy) which is kept at the district’s business office and used for encumbering funds from the proper account.

• Department Requesting Copy-(Pink Copy) which is returned to the department or campus when the purchase order has been paid.

• Media Center-(Gold Copy) which is sent to the Media center (Shipping and Receiving Dept.) and returned back to the district’s business office when the order is received.

Purchase Order Cancellation Procedures

Vendors should be informed of these procedures and cancellation terms should be stated on the face of the purchase order itself. For example, a department or campus may state that a purchase order shall be cancellable if merchandise is not received within 60 days or a certain date may be indicated. Depending on certain factors relating to the purchase, flexible cancellation dates may be more appropriate. The districts cancellation procedures include no backorders, no substitutions, and no additions. Purchase order shall be completed within 2 months. The purchase order will be voided after 2 months, unless specifications to keep the purchase order open is written on the purchase order.

Approving and Processing

The purchase order shall be approved through the campus administrator, business office manager and superintendent. The purchase order shall comply with purchasing laws, policies, and procedures. Purchase orders must be obtained prior to ordering goods and/or services. The activity account clerk shall maintain a record of all purchase orders issued for control purposes. The log should include the date of submission, purchase order number, vendor name, and amount of purchase order and campus/department name.

Amounts Encumbered On Purchase Order

Amounts encumbered on purchase orders must be for the full amount of goods or services needed to be purchased. Freight charges must be included on all purchase orders requiring the payment of freight charges. Amounts entered on purchase orders must be as accurate as possible to ensure no overage charges are made on individual items. Goods and services shall not exceed the amount approved on the

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purchase order over 10%. An additional purchase order is necessary for any overages on invoices. As stated on the purchase orders, no back orders, substitutions, or additions will be allowed.

C. ACTIVITY FUND PAYMENT VOUCHER

Cash disbursements journals are used to record all expenditures of cash. Whenever a check is written, it should be entered into the cash disbursements journal in numerical order by check number. Other transactions which decrease cash may also be entered into the cash disbursements journal with a notation describing the transaction. Examples of these are entries to record bank charges, corrections of errors, and returned checks which do not clear the originating bank. The journal will include the date of the transaction, the amount, and in the case of checks, the payee.

All expenditures shall be paid by check from the appropriate checking account using pre-numbered checks in numerical sequence. No checks will be written without prior authorization from the Business Manager and Superintendent. Authorization will be in writing using the Payment Voucher Form.

IRS Form W-9 shall be required and maintained at the Business Office for ALL vendors. Checks will be made to a specific person, company or organization. If an error is made and it is necessary to void a check the word “void” will be written clearly across the check. Voided checks will be attached to the corresponding check stub in the check book or filed in numerical sequence with the other checks which have been returned by the bank.

A check may be issued to the person authorized (sponsor or other designated person) to make the purchases in an amount adequate to cover the estimated cost of the purchase. The sponsor or designated person will then be required to submit an invoice documenting the amount of the purchase.

In the event that the amount of the check exceeds the cost of the purchase, a cash receipts voucher must be completed and the excess money deposited into the account from which the check was issued. An additional check will be issued when the estimated cost did not cover the expense.

Funds held for either the Student Activity or Campus Account may not be used to cash checks. This practice is strictly prohibited because check cashing is, in effect, a loan until the check has cleared the bank.

Purchases of a personal nature shall not be commingled with purchases made for District use. Personnel cannot use the District’s tax-exempt status to avoid paying sales tax on personal items. If an employee makes both personal and school related purchases from a vendor at the same time, the two purchases shall be rung up separately. Sales tax will not be reimbursed.

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Payment Voucher

Before a check may be written from either the Student Activity or the Campus Account, it must be authorized in writing using the Payment Voucher Form. The purpose of this form is (1) to provide authorization of payment for the expenditure; (2) to document the purpose of the expenditure; (3) to identify the activity account to be charged; and, (4) to verify that there are adequate funds in the activity account to cover the check.

The Payment Voucher Form must be signed manually by the principal, the sponsor, Business Manager, and Superintendent. Under no circumstances will a payment be authorized when there are not sufficient funds in the activity account to cover the check.

No activity account or checking account will be allowed to be overdrawn. Funds must be deposited immediately to cover over drawn accounts.

The check request form is the instrument that provides authorization of the expenditure. All expenditure requires receipts/invoice to document the purchase. Sponsors are required to attach and submit receipts to the activity account clerk. Purchase Order number must be noted on the receipt/invoice. Failure to provide receipts within 3 days may result in the following action:

Additional checks will not be issued to that sponsor.

Additional Documentation

Every check written from either the Student Activity or the Campus Account must be documented further by some additional support. In most cases this will be an original invoice which will be presented along with the Payment Voucher Form. It is required that the Principal insists that the invoice be presented before the check is written. The Principal is responsible for the proper documentation of all disbursements. Once the check has been released, it may be more difficult to obtain the appropriate documentation.

There are some cases when an invoice is not available in advance. The following is a list of alternative forms of support. The list is not all-inclusive. There will be other circumstances which are not covered here. In those cases the Principal should use his or her judgment to obtain the most appropriate written evidence that the expenditure was made to the payee named on the check in the amount indicated on the check and that it was made for a legitimate purpose.

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Alternative forms of support for expenditures

1. A copy of an order form may be used when an order is placed and paid in advance. This could involve periodicals, supplies purchased for a student group, seminar fees, etc. If a receipt or statement documenting a payment is received later, it should be attached to the copy of the order form. Make sure all forms include the purchase order number.

2. Money distributed to students on out of town trips must be documented by the signatures of the students on money disbursed to students, which indicates the date, the amount received by each student, and other pertinent information. In this case the payment voucher should indicate that the funds will be used for a travel advance. The list of student signatures must be submitted to the office no later than five school days following the trip. Money advanced to the sponsor, who is in excess of that used by the students, must be returned at the same time. The amount returned and the receipt number will be noted on the list of signatures. Make sure all forms include the purchase order number.

3. In some cases a payment is made partly from the school account and partly by the LCISD Accounts Payable Department. In those cases the original receipts and invoices must be submitted to the Accounts Payable Department. In order to properly document the expenditure from the Student Activity or Principal’s account, a copy of the original invoice or receipt should be attached to the Payment Voucher Form. There must be a notation on the copy that the original was submitted to the LCISD Accounts Payable Department. Make sure all forms include the purchase order number.

4. When a purchase is to be made from a local vendor and the amount is not known in advance the person requesting the check should estimate as closely as possible the amount needed. Once the purchase has been made the receipt or cash register tape will be attached to the request. If there is money left over it will be turned in and documented with a receipt.

5. Teachers or other employees who expect to be reimbursed by the Campus or Student Activity Account for purchases they make on behalf of the school or a student group must be sure that the expenditure is approved in advance through a purchase order.

This additional documentation is critical to maintaining control over the student activity and campus accounts. It is the responsibility of the sponsor or other designated employee who requests a check to provide all of the support required in this section. However, it is ultimately the Principal’s responsibility to see that these requirements are met. Principals should enforce these procedures by withholding additional checks to sponsors who have not provided documentation required for checks written previously.

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Student and Campus Activity Funds Payment Process 1. Submit a manual Purchase Order (PO must first be sent to the Student Activity Clerk at the business office before the Superintendent signs off on it). PO must be printed on a 4-part form. Make sure detail descriptions of all services/items (item #) event/service dates, purpose, qty, etc. are noted on the PO. Quote may be attached to the PO. Do not attach an invoice to a purchase order that has not been approved. Be advised, placing an order/making a purchase prior to a Purchase Order approval by your supervisor, business manager and superintendent, will make you responsible and liable for the charges. 2. Purchase orders which include student travel through activity account should have the following approved form attached:

a. Request for approval of out of classroom activity form or b. Request for approval of overnight trip form

3. Fundraising activities have prior approval from the Superintendent through a Special Activity Form. The approved form must be included with the purchase order. 4. Travel expense statement (for mileage reimbursement). 5. Copy of per diem allowance (for meal reimbursement/payment). 6. Food purchased for meetings must include a list of attendees, business purpose, and a copy of the meeting agenda. 7. Once Purchase Order is approved with all signatures, PO # is issued to process the order/service. The WHITE COPY of the PO goes to the VENDOR. The GOLD COPY goes to the MEDIA CENTER. Keep a copy of the approved PO for your records. 8. Complete a Payment Voucher and attach the invoice for the order/service you are paying for. MAKE SURE PO# APPEARS ON INVOICE (If vendor failed to include it on the invoice, you may write it in). 9. Payment Voucher must be turned in to the business office 3 business days prior to date needed. 10. Checks are issued every Wednesday and Friday. Incomplete documents will not be accepted.

Voiding Outstanding Checks

It will occasionally be necessary to void a check which has been outstanding for more than six months, has been lost, or has been returned for some reason. The following steps should be followed:

1. If the check has been lost, a Stop Payment order should be requested from the bank if the amount of the check is greater than the stop payment fee.

2. On the Payment Voucher Form, note that the check has been voided, the date, and the reason for voiding the check. If a new check is being issued, note the check number of the new check as a cross reference. (The new Payment Voucher Form will also note that the check is being issued as a replacement for a prior check. It will include the number of the original check as a cross reference.)

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3. The amount of the voided check is to be added back to the bank balance of the appropriate activity account by means of an entry in the cash receipts journal.

4. The voided check will be taken off of the outstanding check list on the bank reconciliation.

5. If the voided check is available, mark it “void” across the face of the check and staple it to the corresponding stub in the check register or file it in numerical sequence with the cancelled checks received from the bank.

D. PRE-NUMBERED CHECKS

Pre-numbered checks are used to disburse all funds from the Activity Fund checking account. Checks must be printed with the school name and type of fund. When ordering additional checks, the new check numbers should begin with the number succeeding the last check used.

E. BANK DEPOSITS

Bank deposits shall be made by the activity account clerk or other designated employee on a weekly basis (unless there is less than a $100.00).The activity account clerk will count all cash and checks on hand. This total should agree with the total of all receipts issued since the last deposit. Any discrepancy must be reconciled immediately. The activity account clerk shall require from the sponsor(s), a copy of all checks received at the time of delivery of checks to the bookkeeper or student activity clerk. It provides assurance that all cash received has been deposited. Bank deposits will be prepared in triplicate. The original is sent with the deposit; one copy is maintained by the activity account clerk as a file copy, and the second copy remains in the deposit book as a chronological record of the deposit with the sponsor. The original deposit slip will be returned with the bank statement and should be filed with the statement.

Bank Deposit Slips

These slips serve as transmittal advice to the bank and your record of funds deposited in the bank on specific dates. Deposit slips are obtained from the bank as needed and must be printed in triplicate with the school district’s activity fund account name.

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Transfers between Accounts

It is not necessary to write a check to transfer funds from one account to another within the same bank account. However, the transfer must be documented by a transfer of funds form. The form will be completed by the sponsors and approved by the principal and business manager. Even though transfers do not involve releasing checks, they are never to be made without the written approval of the Principal and the representatives of the club “spending” the money.

An entry will be made in the cash receipts and disbursements journal to record both the disbursement and the deposit. The notation “transfer” will be made along with a brief description of the reason for the transfer.

F. MONTHLY BANK STATEMENTS

The bank statement is the official bank record reflecting all transactions affecting the cash balance on deposit during the preceding month. When properly reconciled, the statement serves as an official support for the cash balance indicated in the activity fund records. A bank statement should be reviewed and reconciled monthly for all accounts. All monthly bank reconciliation needs to be filed at the campus/department and business office.

G. PREPARATION OF RECORDS

All records must be completed in ink. All corrections must be approved by the campus principal. The use of “white-out” is prohibited.

III. SECTION-BANKING PRACTICES AND PROCEDURES

A. BANK ACCOUNTS

All student activity funds and campus funds will be kept at the LCISD designated depository bank. The account title must be identified as an LCISD account and include the name of the school and must be imprinted on all checks and deposit slips. All funds received will be deposited into the bank account and all disbursements will be made by check from the account.

Each bank account shall have at least two authorized check signers. No check will be signed until the check has been completely filled out with the date, payee, and amount. The student activity account ledger must be reconciled to the monthly bank statements in a timely manner by the activity account clerk and overseen by the Business Manager.

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B. CHECK SIGNATURES

Financial clerks and secretaries are not permitted to sign checks. Checks require two signatures from the authorized list of signatures on file at the bank (Board of Trustees President and Board of Trustees Secretary). Each check is stamped signed by the pre-numbered Certex Check Signer.

C. ACTIVITY ACCOUNT RECONCILIATION

The activity account clerk should prepare a monthly financial report for each student organization, showing the organization's cash receipts and disbursements. These reports should be reviewed by the Campus Principal and submitted to the student organization's sponsor. Each sponsor should then compare the report prepared by the activity account clerk with the sponsor's records (cash receipts, purchase orders, payment vouchers and sales tax report). Any discrepancies should be resolved immediately. Request for activity account balances, purchase orders, deposit status or payments must be completed on a request for records form. Additionally, the school business office should periodically perform internal audits of the reports and supporting records.

IV. SECTION-OTHER ISSUES

A. CONFLICT OF INTEREST

All campus personnel including bookkeepers, student activity clerks and faculty sponsors who are involved in the disbursement of campus and student activity funds will sign a Conflict of Interest Disclosure. These forms will be maintained by the Business Office.

B. INVESTING CAMPUS AND STUDENT ACTIVITY FUNDS

All investment transactions must be handled by the Business Office in accordance with Board approved investment policies and procedures.

C. FIXED ASSETS

Fixed assets including computers, furniture, playground equipment, scoreboards, etc. that are purchased with campus or student activity funds will become the property of the Lyford Consolidated Independent School District. It is the responsibility of the principal to see that the fixed asset is tagged and included in the fixed asset inventory of the district.

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D. PARENT ORGANIZATIONS

Funds raised by outside groups such as PTA, band boosters, and so forth are the responsibility of the officers of the organization. The TEA Financial Accountability System Resource Guide states that using the resources of the school district to account for such funds could be in violation of the section of the Texas Constitution that prohibits the appropriation of public funds for individual or private purposes. Funds belonging to these groups will not be accounted for either in the Student Activity or in the Campus Accounts. (Texas Education Agency Financial Accountability System On-Line Resource Guide)

E. PAYMENTS TO NON-EMPLOYEES FOR CONTRACTED SERVICES

When payments are made to non-employees for contracted services, a Contract for Consultant Services should be completed as well as a W-9 Form. Please see Human Resources for the Contract for Consultant Services form. Additional requirements might have to be met. The Contract for Consultant Services form shall include the name and social security number of the non-employee, as well as a description of the services to be provided and the amount of compensation, must be completed before the services are rendered. The Business Office will aggregate the data from all sponsors and issue 1099 Forms as required by the Internal Revenue Service. Note that club sponsors may not pay non-employees using either their own personal check or cash and then seek reimbursement from the activity fund. A W-9 must be completed for all vendors (motivational speakers, choreographers, seamstress, DJ services, clown performances, etc.). W-9 from the vendor must be on file prior to services rendered. Once the W-9 is received the vendor will be added to the Student Activity and Campus Accounts Approved Vendor List. The District doesn’t keep a contracted services agreement on file for officials and/ or judges because the officials don't work in isolation with students. Therefore, we don't run a Contracted Services Agreement through HR. TASO screens Varsity officials for any assault, sexual, or drug offense. TASO does not screen Sub-Varsity officials.

F. YEARBOOKS

The cost of producing yearbooks should be recovered from the current year sales of yearbooks and advertising. It is the responsibility of the principal to supervise this activity. All yearbook orders including modifications of the original order must be authorized in writing by the principal. The cost of the yearbook must be constantly compared to the projected revenue from yearbook sales, advertising and other sources. It is recommended that principals meet monthly with the yearbook sponsors to monitor both the total cost of the yearbook and the total revenue collected. In an effort to assist the yearbook sponsors, the Business Office may request annual bids or proposals in order to obtain the best prices for

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the yearbook. It is the responsibility of the principal to coordinate with the Business Department of such activity.

G. PICTURE SALES

Picture fundraisers are an important event to the school and to the community in that it provides for recognition of the student’s growth and identification on an annual basis. Schools are encouraged to have picture events at their schools; however, the Business Office will need to seek bids or proposals for each campus depending on the number of pictures needed. The bid or proposal shall include a picture for all students and the offering of a basic –affordable package. Other packages may be offered as well. It is the responsibility of the principal to coordinate with the Business Department of such activity.

Request for New Activity Fund Account Date of Request: ___________________ Campus: ______________________________ Proposed Name of Account: ________________________________________________

Mission or Purpose of the Account

Sources of Income

Name of Sponsor Sponsor’s Signature Principal/Administrator Approval: ____________________________ Date: __________

Business Manager Approval: ________________________________ Date: __________

FOR OFFICE USE ONLY

NAME OF NEW ACCOUNT

NEW ACCOUNT NUMBER

ASSIGNED BY THE ACTIVITY ACCOUNT CLERK ASSIGNED BY THE ACTIVITY ACCOUNT CLERK

RESPONSIBLITIES OF FACULTY SPONSORS OF STUDENT GROUPS

SCHOOL YEAR _________________________ The purpose for the collecting or raising and expending of funds by student groups is for the direct benefit of the students. Funds are to be used to finance activities which supplement the educational curriculum of the District. Fund raising activities will contribute to the educational experience of the pupils and will not conflict with the instructional program. Money raised by student groups and organizations are held by the school as trustee. The faculty sponsor of a student club or group is responsible for maintaining adequate financial records as evidence of proper custodianship of money received by and distributed from club accounts. I hereby acknowledge that I have read the LCISD Campus and Student Activity Funds Manual and that I am responsible for complying with it. In particular, I acknowledge that:

1 All fund raising activities will be approved in advance by the principal using the designated form.

2 I am responsible for both safeguarding and accounting for funds received from and/or on

behalf of students.

3 Student activity money will be turned into the office daily in the same form in which it was received.

4 At the completion of all funds raised the Fund Raiser Report will be completed and

submitted to the principal for approval.

5 All purchases made on behalf of the student organizations will be made by check and approved in advance by the principal using the Check Request Form.

6 In general, no purchases will be made “on account”. Exceptions to this rule will be pre-

approved in writing by the principal.

7 I will maintain a positive balance in my organization’s account at all times. I understand that I will be held responsible for student activity funds entrusted to me and that I will reimburse the student organization for any money (or property purchased with student activity money) which is lost due to carelessness, theft or fraud. _________________________________ Sponsor’s Name _________________________________ ___________________ Sponsor’s Signature Date _________________________________ Student Group and Account No.

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PAGE # 1

REQUEST FOR FUNDRAISER AND FUNDRAISER RECAP REPORT

This form will be used for all fundraising activities. Before any activity has begun, the principal or other campus administrator is required to authorize the organization to proceed with the project. Within ten school days of the completion of the project, the faculty sponsor must complete page number 3 to justify all funds raised and all expenditures.

REQUEST FOR FUNDRAISER (ATTACH TO SPECIAL ACTIVITY FORM)

SCHOOL YEAR: _________________________ DATE OF FUNDRAISER: START__________________ END________________

ACTIVITY ACCOUNT NAME

ACTIVITY ACCOUNT NUMBER CAMPUS

DATE REQUESTED FOR FUNDRAISER PURPOSE OF FUNDRAISER

DESCRIPTION OF FUNDRAISER

WILL A FOOD ITEM BE SOLD WITH THIS FUNDRAISER REQUEST? ___ NO PROCEED WITH PAGE 1 AND 3 ONLY

___ YES IF YES, PLEASE COMPLETE THIS PAGE AND PAGE 2 TO DETERMINE ELIGIBILITY FOR FOOD FUNDRAISER AND 3 FOR RECAP.

DESCRIBE WHAT EXPENDITURES WILL BE INCURRED WITH THIS FUNDRAISER (COST TO PURCHASE THE PRODUCT, COST TO MAKE THE PRODUCT TO BE SOLD, ETC.)

ESTIMATED EXPENSES: $ ESTIMATED PROFIT: $

IS THIS FUNDRAISER AN EVENT OR ACTIVITY THAT WILL BE HELD AT A SPECIFIC LOCATION: ___YES ___NO

IF YES, WHERE?________________________________________________________________________________________

IF THIS FUNDRAISER IS AN EVENT OR ACTIVITY THAT WILL BE HELD ON SCHOOL PROPERTY, PLEASE CONTACT THE SUPERINTENDENT’S OFFICE TO INQUIRE ABOUT FACILITY AVAILABILITY (956-347-3900). ALL FACILITY REQUESTS MUST BE SUBMITTED AT LEAST 3 WEEKS PRIOR TO EVENT.

IS THIS ONE OF YOUR TWO ONE-DAY TAX-FREE SALES? ___ YES ___NO *COMPLETE A SALES TAX REPORT*

SPONSOR’S PRINTED NAME SPONSOR’S SIGNATURE

PRINCIPAL/ADMINISTRATOR PRINTED NAME PRINCIPAL/ADMINISTRATOR SIGNATURE

FOR CENTRAL OFFICE ADMINISTRATION ONLY

DATE RECEIVED BY BUSINESS OFFICE: ____________________ DATE RECEIVED BY SUPERINTENDENT’S OFFICE: _______________________

SUPERINTENDENT: ____ APPROVED ____ DENIED SUPERINTENDENT’S SIGNATURE: ___________________________________________

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PAGE # 2

ACTIVITY ACCOUNT NAME

ACTIVITY ACCOUNT NUMBER CAMPUS

LIST IN DETAIL THE FOOD ITEMS YOU ARE PROPOSING TO SELL:

PLEASE REVIEW AND SELECT WHICH OPTION BELOW DESCRIBES YOUR FOOD FUNDRAISER OPTION 1

THE FOOD ITEMS ARE NOT READY TO CONSUME-TYPE ITEMS AND CAN BE SOLD DURING THE DAY. IF THIS OPTION IS SELECTED, NO CALCULATOR TOOL IS NECESSARY.

OPTION 2 THE FOOD ITEMS ARE READY TO CONSUME-TYPE AND WANT TO SELL THEM DURING THE SCHOOL DAY. IF THIS OPTION IS SELECTED, THE CALCULATION TOOL IS REQUIRED TO DETERMINE IF YOUR FOOD ITEMS CAN BE APPROVED. PLEASE COMPLETE THE CALCULATOR TOOL. IF YOUR ITEMS PASS THE CALCULATOR TEST, PLEASE ATTACH A COPY OF THE TEST APPROVAL AND COPY OF THE FOOD LABEL(S) TO THIS FUNDRAISER REQUEST AND SUBMIT TO YOUR PRINCIPAL FOR THEIR APPROVAL AND THEN TO THE BUSINESS OFFICE. IF YOUR FOOD ITEM(S) DOES NOT PASS THE CALCULATOR TEST, THEN YOU WILL NOT BE ABLE TO HAVE THE FUNDRAISER. CALCULATOR TOOL: https://foodplanner.healthiergeneration.org/calculator/

OPTION 3 MY FOOD ITEMS ARE READY TO CONSUME-TYPE ITEMS, HOWEVER, THEY WILL NOT BE SOLD DURING THE SCHOOL DAY. IF THIS OPTION IS SELECTED, NO CALCULATOR TOOL IS NECESSARY.

OPTION 4 THE FUNDRAISER IS A BROCHURE OR CATALOG AND MY ITEMS WILL NOT BE RELEASED TO STUDENTS UNTIL THE END OF THE SCHOOL DAY.

MY SIGNATURE BELOW AFFIRMS MY CHOICE OF: ____ OPTION 1 ____ OPTION 2 ____OPTION 3 ____OPTION 4

I FURTHER AGREE TO ABIDE BY THE FEDERAL REGULATIONS WITHIN MY CHOSEN OPTION.

______________________________________________________ _____________________________________________________ SPONSOR PRINCIPAL

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FUNDRAISER RECAP REPORT (ATTACH TO CASH RECEIPT VOUCHER)

NOTE: If more than one kind of item is sold, do not complete this section. Complete a worksheet providing the number and selling price of each unit. NUMBER SOLD ________________ SELLING PRICE PER UNIT X_______________ GROSS PROFIT $_______________ (Number sold x selling price per unit)

EXPENSES: CK NO PAYEE: AMOUNT ____________________________ _______________________________________________ $______________ ____________________________ _______________________________________________ $______________ ____________________________ _______________________________________________ $______________

NET PROFIT (GROSS PROFIT MINUS EXPENSES) $______________

LIST BELOW THE RECEIPT NUMBERS AND AMOUNTS OF DEPOSITS MADE FOR THIS ACTIVITY. RECEIPT AMOUNT ____________________________ $_______________ ____________________________ $_______________ ____________________________ $_______________ TOTAL FROM BACK OF FORM $_______________ TOTAL DEPOSITED $______________

This section must be signed by the faculty sponsor and principal when form is complete. SPONSOR’S SIGNATURE _______________________________________________ DATE ____________________ PRINCIPAL/ ADMINISTRATOR SIGNATURE__________________________________ DATE ____________________

FOR CENTRAL OFFICE ADMINISTRATION ONLY

DATE SUBMITTED: ______________

ACTIVITY CLERK’S SIGNATURE: ___________________________________________

Smart Snacks: State Agency Fundraising Exemption

As of July 1, 2014, schools that participate in the National School Lunch Program (NSLP) are required to abide by the nutrition standards laid out in the Interim Final Rule on All Foods Sold In School: Smart Snacks. These standards focus on all foods sold on the school premises during the school day and are not a part of the NSLP or School Breakfast Program (SBP). This includes additional a la carte entrees, sides, beverages, items sold in vending machines or school stores, and food focused fundraisers. More information on the standards can be on the USDA Website.

The Smart Snacks standards allow state governments to develop a policy on the number of exemptions for food fundraisers that do not meet the standards. The chart on the right provides you with the number of exemptions a state will allow, with the below information detailing the entirety of a state’s policy including duration and if the number is per building or organization. SNA extends our thanks to the State Agencies that helped provide the information included here.

The information contained within this report is up to date and factual to the best of our knowledge. It will be updated as policies change.

The following 29 states will not have a policy, thus defaulting to zero exempt fundraisers: AL, AK, AZ, CA, CT, DE, HI, IA, KY, LA, ME, MD, MA, MI, MS, MT, NV, NJ, NH, NY, NC, OH, OR, RI, TX, VA, VT, WA, and WV.

Summary of States with Exemption Policies As of October 28, 2014

Arkansas: Nine school days (selected in advance and placed on school calendar) for all grades when the Arkansas Nutrition Standards do not apply. Information confirmed by State Agency staff.

Colorado: Three exemptions per school building.

Florida: Five exemptions for ES, but 10 days/year/campus for MS, 15 days/year/campus for HS, and 10 days/year/campus for combination schools. Fundraisers cannot take place until one hour after the last meal service, and if any part of the exchange happens on the school campus, it is considered a fundraiser.

Georgia: Thirty per year, per building, not lasting more than three days.

State Exemptions Alabama None Alaska None Arizona None Arkansas Nine California None Colorado Three Connecticut None Delaware None Florida 5ES/10

MS/15HS Georgia Thirty Hawaii None Idaho Ten Illinois 9 ES/36 HS for

SY2014-2015 Indiana Two Iowa None Kansas One Kentucky None Louisiana None Maine None Maryland None Massachusetts None Michigan None Minnesota Case by Case Mississippi None Missouri Five Montana None Nebraska Two Nevada None New Hampshire None New Jersey None New Mexico One New York None North Carolina None North Dakota Three Ohio None Oklahoma 30 Oregon None Pennsylvania 10HS/5ES,MS Rhode Island None South Carolina Pending South Dakota One Tennessee Thirty Texas None Utah Three Vermont None Virginia None Washington None West Virginia None Wisconsin Two Wyoming Five

State Agency staff will consider additional ones on a case by case basis. Items cannot be sold until 30 minutes after meal time. (Proposed)

Idaho: Ten exempted fundraisers per year, per school site. Each fundraiser must not be longer than four consecutive days. School districts will be able to request approval for additional fundraisers from the state Department of Education.

Illinois: Two-year phased out process that is different at the ES/MS and HS level. For HS, in year one, there are 36 exemption days and nine starting in school year 2015-2016 and beyond. For ES/MS, there are nine in year one and zero starting in school year 2015-2016 and beyond.

Indiana: Two fundraisers per year per building, and they may not last more than one day.

Kansas: Each school group may have one fundraiser per semester, which shall last two days.

Minnesota: LEAs may apply for exemptions over the next few years but aim to phase out completely.

Missouri: Five per year per school building over one day.

Nebraska: Two per organization per semester lasting two days.

New Mexico: One per school, per year.

North Dakota: Three per building lasting one day, per year.

Oklahoma: 30 per school site per semester for a period of 14 days each.

Pennsylvania: Allows 10 for HS, five for ES and MS and can last one week.

South Carolina: As of October, proposed rule to allow 30 per school per year lasting three days.

South Dakota: One per school-sponsored organization per year lasting one day. Non-school sponsored may not hold exempt fundraisers.

Tennessee: 30 per year, per site.

Utah: Three fundraisers per site, per year, which can last no more than five days.

Wisconsin: Two fundraiser exemptions per student organization, per school year.

Wyoming: Five fundraisers per school, which can last up to two weeks.

LYFORD CONSOLIDATED INDEPENDENT SCHOOL DISTRICT

Cash Receipt Voucher

Account Number

Account Name

Funds collected (itemized below): Qty Denomination

CURRENCY @ $ 100 's AMOUNT $

CURRENCY @ $ 50 's AMOUNT $

CURRENCY @ $ 20 's AMOUNT $

CURRENCY @ $ 10 's AMOUNT $

CURRENCY @ $ 5 's AMOUNT $

CURRENCY @ $ 1 's AMOUNT $

COINS (please enter total coins at right) AMOUNT $

CHECKS AMOUNT $

Total amount submitted for deposit $

(please enter total of checks at right)

Amount counted by Business Office $

Responsible Party ____________________________________ Date _________________

Principal/Asst. Principal/Director/

For Business Office Use Only

Verified by: __________________________________________ Date _________________

Witness: ____________________________________________ Date _________________

If amounts were different please indicate why and initial:

___________________________________________________________________________________

___________________________________________________________________________________

White: Business Office (File) Yellow: Business Office (Witness) Pink: Prin/Asst Prin/Dir/Supv Gold: Responsible Party

I have verified that receipt(s) and deposit amount equal (Responsible Party initials): _______________

______________________ Date _________________

CAMPUS:__________________________SPONSOR:_____________________________

CLUB:_____________________________DATE: _______________ ROOM #: ________

PURPOSE:

AMOUNT1.2.3.4.5.6.7.8.9.

10.11.12.13.14.15.16.17.18.19.20.21.22.

TOTAL DISBURSED: $

STUDENT NAME STUDENT SIGNATURE

LYFORD CONSOLIDATED INDEPENDENT SCHOOL DISTRICTTRANSMITTAL LIST

MONEY DISBURSED TO STUDENTSPrint Name

Sponsor Signature/Date

Request for Acceptance of Donated Items

TO:

FROM:

SUBJECT: DONATION/GIFT NAME OF DONOR (IF ORGANIZATION, PLEASE INCLUDE NAME OF PRESIDENT) MAILING ADDRESS CITY STATE ZIP CODE HAS OFFERED THE FOLLOWING DONATION: DESCRIPTION OF GIFT VALUE ________________________________________________________ _______________ ________________________________________________________ _______________ ________________________________________________________ _______________ Permission is requested to accept this donation/gift for our school/department. The donor understands that this donation/gift will become the property of the Lyford CISD and will be under the jurisdiction of the school/department in accordance with School Board Policy and administrative rules and regulations. Approved donations/ gifts should be added to fixed asset inventory, if applicable. REMARKS: APPROVAL DISAPPROVAL APPROVAL DISAPPROVAL __________________________________ __________________________________ SUPERINTENDENT/DATE BOARD OF TRUSTEES/DATE

White (Business Office) Yellow (Principal) Pink (Sponsor #1 “TO”) Gold (Sponsor #2 “FROM”)

SCHOOL CAMPUS ___________________________

INTERNAL TRANSFER FORM Transfer Amount: $_______________

From: ______________ _________________________________ Account Number Account Name

To: ______________ _________________________________ Account Number Account Name

Explanation: _________________________________________________________

_________________________________________________________

Signatures: _________________________ Principal/Date

Signatures: _________________________ _____________________________ Teacher/Sponsor (FROM)/Date Teacher/Sponsor (TO)/Date

Signatures: _________________________ ___________________________ Business Manager/Date Activity Accounts Clerk/Date

Posting/Document #__________________ Posting Date __________________ (Document # in EPES) (Document # in EPES)

Transfer Directions: A. This form is required to document the transfer of funds from one internal account to another.

Number all transfer forms consecutively, beginning with number 1, and post this number as the “Document #”.

B. All transfer forms must be signed by the Principal. C. Post this information to your school software: Click File – Transfers & Deposits – Activity

Account Transfer

PO BOX 220, LYFORD, TX 78569

Tax Ex. No. 1-74-6001648-2 PO#_______________

White-Vendor Yellow-Business Office Pink-Requesting Staff Gold-Media Center

PURCHASE ORDER FORM

Date Prepared _____________________ Account Name_____________________ Vendor Code_______________________ Account Number___________________

TO: SHIP TO: LCISD MEDIA CENTER INVOICE TO: LYFORD CISD 8120 SIMON GOMEZ BLVD ACTIVITY ACCOUNTS LYFORD, TX 78569 PO BOX 220 PHONE: 956.347.3904 LYFORD, TX 78569 FAX: 956.347.5201 FAX 956.347.3921

PURPOSE OF EXPENDITURE: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ TERMS AND CONDITIONS:

1. Mail 2 copies of invoice to the invoice address provided above. 2. Lyford CISD assumes no responsibility for purchases not on this form. 3. The above PO# must appear on all invoices and packages to be considered for payment. 4. The District is exempt from Federal Transportation & Excise Taxes and State Sales Tax. 5. No C.O.D. shipments of any character will be accepted; delivery terms are F.O.B. destination. 6. Transportation charges, if any, should be prepaid and added to the invoice. 7. This order is null and voided unless signed by the Superintendent/designee and the Business Manager. 8. Payment will be made within 30 calendar days after the latest of the following 3 dates unless otherwise specified in this contract: (1) the date on which LCISD received complete

delivery of all supplies, materials, equipment, and/or services, or (2) the date on which performance is complete and satisfactory to LCISD, or (3) the date on which the invoice is received.

9. Under NO CIRMCUMTANCES should any interest or penalty be added to the amount due.

Requesting Staff Signature and Date___________________________________________________________ Supervisor’s Signature and Date___________________________________________________________ Business Manager’s Signature and Date__________________________________________________________ Superintendent’s Signature and Date___________________________________________________________

FOR OFFICE USE ONLY Account Balance $____________________________

PO was received at the business office on: ______________ Approved PO was received at the business office: ________________

DESCRIPTION & ITEM NO. QUANTITY UNIT PRICE AMOUNT

TOTAL

Comments:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PAYMENT VOUCHER

Before submitting this form to the Activity Account Clerk, REMEMBER:

1. Only claim your expenses. Do not claim expenses of others. 2. Account code has been provided on the form. 3. Personal CC purchases; attach proof of purchase (ex. Order form packing slip, cc statement, etc.) 4. All receipts/invoice must be itemized and must include the purchase order number. Original receipts ONLY! 5. Food purchased for meetings must include a list of attendees, business purpose and a copy of the meeting agenda. 6. All necessary approvals have been obtained prior to purchase or service through a purchase order. This form needs to be turned in 3 days prior to date needed. Every blank must be completed and purpose of expenditure clearly stated so that the administrators can consider approval of the request. Unapproved requests will be returned to the principal

Campus: ___________________________________________________ Date: ___________________

Pay to: _____________________________________________________ Amount: $_______________

Mailing Address: _____________________________________________ Tax ID #: _________________

______________________________________________ Account # ________________

______________________________________________ Account Name ____________

Is payee a district employee? Yes___ No___ Invoice # ________________________ PO# _________

Purpose of expenditure: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

FOR OFFICE USE ONLY

Date PV was Rcvd. from the Sponsor: ______________ Date PV was approved: ________________

Signature of person picking up the check/Date: ________________________________________________________________

Activity Accounts Clerk’s Signature/Date: _____________________________________________________________________

Check No. ____________ Date issued___________

By signing this statement, I authorize the district to Payroll Deduct any unsubstantiated amounts. Unsubstantiated amounts include, but are not limited to, those for which a receipt has not been provided. All receipts must be attached to this form. If a check is needed prior, receipts must be provided within 3 business days from the date check was issued. Sponsor Printed Name

Club Sponsor Signature

Balance in account before this check: $ _____________

Approved: Yes ___ No ___

Principal’s/Admin. Signature_______________________________

Approved: Yes ___ No ___

Business Manager’s Signature______________________________

Approved: Yes ___ No ___

Superintendent’s Signature ______________________________

Form W-9(Rev. December 2014)Department of the Treasury Internal Revenue Service

Request for Taxpayer Identification Number and Certification

Give Form to the requester. Do not send to the IRS.

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2.

1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.

2 Business name/disregarded entity name, if different from above

3 Check appropriate box for federal tax classification; check only one of the following seven boxes:

Individual/sole proprietor or single-member LLC

C Corporation S Corporation Partnership Trust/estate

Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ▶

Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for the tax classification of the single-member owner.

Other (see instructions) ▶

4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):Exempt payee code (if any)

Exemption from FATCA reporting

code (if any)(Applies to accounts maintained outside the U.S.)

5 Address (number, street, and apt. or suite no.)

6 City, state, and ZIP code

Requester’s name and address (optional)

7 List account number(s) here (optional)

Part I Taxpayer Identification Number (TIN)Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.

Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter.

Social security number

– –

orEmployer identification number

Part II CertificationUnder penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and

2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and

3. I am a U.S. citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3.

Sign Here

Signature of U.S. person ▶ Date ▶

General InstructionsSection references are to the Internal Revenue Code unless otherwise noted.

Future developments. Information about developments affecting Form W-9 (such as legislation enacted after we release it) is at www.irs.gov/fw9.

Purpose of FormAn individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following:

• Form 1099-INT (interest earned or paid)

• Form 1099-DIV (dividends, including those from stocks or mutual funds)

• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)

• Form 1099-B (stock or mutual fund sales and certain other transactions by brokers)

• Form 1099-S (proceeds from real estate transactions)

• Form 1099-K (merchant card and third party network transactions)

• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition)

• Form 1099-C (canceled debt)

• Form 1099-A (acquisition or abandonment of secured property)

Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.

If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding? on page 2.

By signing the filled-out form, you:

1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),

2. Certify that you are not subject to backup withholding, or

3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and

4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting? on page 2 for further information.

Cat. No. 10231X Form W-9 (Rev. 12-2014)

Eduardo Infante, Superintendent

Post Office Drawer 220 • Lyford, TX 78569-0220 • (956) 347-3900 • Fax (956) 347-5588 BOARD OF TRUSTEES www.lyfordcisd.net Marina Quilantan-Rivera– President

Cruz Salinas– Vice-President Viola Z. Vela – Secretary

Alison Busse-Savage – Trustee Arnold Cortez– Trustee

Joey Mendoza– Trustee Mike Hinojosa–Trustee

Consultant and Contracted Services Agreement

This agreement is made and entered into by and between Lyford CISD and , referred to as “Consultant.” The parties have severally and collectively agreed and by the execution hereof are bound to the mutual obligations and to the performance and accomplishment of the tasks hereinafter described. Consultants shall provide professional services, consultation, and expertise to the District for use and benefit of public education in Texas.

The District shall pay consultant: Consultant Fee q daily q session q per participant

Estimated Travel Expenses Hotel Per Diem/Meals Airline

Car Rental Mileage

Other (please specify)

The combined total of all payments shall in no event exceed the sum of:

$

All expenses incurred during the contract period are the responsibility of the consultant. Reimbursements will occur with original receipts for expenses noted above.

Date of Service

Beginning Date

Ending Date

or Dates of Service

Funding Code(s)

Description of Service(s)

Will the Consultant/Contracted service and/or his/her employees have direct unsupervised contact with students? q Yes q No (If Yes, attach Addendum A or Addendum B AND DPS Computerized Criminal History (CCH) Verification.)

Administrator Date

Business Manager Date

Approved and accepted by Lyford CISD

Superintendent

this day of , .

This agreement in all its particulars is subject to all Federal and Texas State laws, rules and regulations pertaining to the project and the funding source(s).

SS#/Federal ID# Address

City State Zip Phone

Approved and accepted by Consultant

Signature

this day of , .

Additional Comments:

Eduardo Infante, Superintendent

Post Office Drawer 220 • Lyford, TX 78569-0220 • (956) 347-3900 • Fax (956) 347-5588 BOARD OF TRUSTEES www.lyfordcisd.net Marina Quilantan-Rivera– President

Cruz Salinas– Vice-President Viola Z. Vela – Secretary

Alison Busse-Savage – Trustee Arnold Cortez– Trustee

Joey Mendoza– Trustee Mike Hinojosa–Trustee

ADDENDUM A Notification to Independent Consultant for Contracted Services

Introduction: Texas Education Code Chapter 22 requires an independent consultant who provides services to a school district to submit to a criminal history review if the independent consultant will have continuing duties related to the contracted services and direct student contact. Each independent consultant must certify with the District that the consultant has complied.

A covered independent consultant with a disqualifying criminal history is prohibited from serving at the District. The following offenses are disqualifying if, at the time of the offense, the victim was under 18 or enrolled in a public school:

a) A felony offense under Title 5, Texas Penal Code; b) An offense for which a defendant is required to register as a sex offender under Chapter 62, Texas Code of Criminal procedure; or c) An equivalent offense under federal law or the laws of another state.

The District reserves the right to designate other convictions or other criminal history information as disqualifying.

I certify that I have obtained all required criminal history record information regarding myself through the Texas Department of Public Safety’s Fingerprint-based Applicant Clearinghouse of Texas (FACT). I further certify that I do not have a disqualifying criminal history. I agree to notify the District in writing within three (3) business days if I am arrested or adjudicated for a disqualifying reason during the contract term.

I agree to provide the District, upon request, my full name and any other requested information so that the District may obtain my criminal history record information. I understand that the District may terminate my services at any time if the District determines, at its sole discretion, that my criminal history is not acceptable.

Noncompliance or misrepresentations regarding this certification may be grounds for contract termination.

Print Name Date of Birth

Signature Date

Eduardo Infante, Superintendent

Post Office Drawer 220 • Lyford, TX 78569-0220 • (956) 347-3900 • Fax (956) 347-5588 BOARD OF TRUSTEES www.lyfordcisd.net Marina Quilantan-Rivera– President

Cruz Salinas– Vice-President Viola Z. Vela – Secretary

Alison Busse-Savage – Trustee Arnold Cortez– Trustee

Joey Mendoza– Trustee Mike Hinojosa–Trustee

ADDENDUM B Notification for Consultant with Employees

Introduction: Texas Education Code Chapter 22 requires an independent consultant who provides services to a school district to submit to a criminal history review if the independent consultant will have continuing duties related to the contracted services and direct student contact. Each independent consultant must certify with the District that the consultant has complied.

Definitions: Covered employees: Employees of a consultant who have or will have continuing duties related to the service to be performed at the District and have or will have direct contact with students. The District will be the final arbiter of what constitutes direct contact with students.

Disqualifying criminal history: Any conviction or other criminal history information designated by the Center, or one of the following offenses, if at the time of the offense, the victim was under 18 or enrolled in a public school:

a) A felony offense under Title 5, Texas Penal Code; b) An offense for which a defendant is required to register as a sex offender under Chapter 62, Texas Code of Criminal procedure; or c) An equivalent offense under federal law or the laws of another state

On behalf of (“Consultant”), I certify that [check one]:

q None of the employees of Consultant are covered employees, as defined above. If this box is checked, I further certify that Consultant has taken precautions or imposed conditions to ensure that the employees of Consultant will not become covered employees. Consultant will maintain these precautions or conditions throughout the time the contracted services are provided.

OR

q Some or all of the employees of Consultant are covered employees. If this box is checked, I further certify that: 1) Consultant has obtained all required criminal history record information regarding its covered employees. None of the covered

employees has a disqualifying criminal history. 2) If consultant received information that a covered employee subsequently has a reported criminal history, Consultant will

immediately remove the covered employee from contract duties and notify the District in writing within three (3) business days.

3) Upon request, Consultant will provide the District with the name and any other requested information of covered employees so that the District may obtain criminal history record information on the covered employees.

4) If the District objects to the assignment of a covered employee on the basis of the covered employee’s criminal history record information, Consultant agrees to discontinue using that covered employee to provide services at the District.

Noncompliance or misrepresentations regarding this certification may be grounds for contract termination.

Print Name Date of Birth

Signature Date

Revised 11/30/2015Form provided by Texas Ethics Commission www.ethics.state.tx.us

FORM CIQ

OFFICE USE ONLYThis questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.

This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor whohas a business relationship as defined by Section 176.001(1-a) with a local governmental entity and thevendor meets requirements under Section 176.006(a).

By law this questionnaire must be filed with the records administrator of the local governmental entity not laterthan the 7th business day after the date the vendor becomes aware of facts that require the statement to befiled. See Section 176.006(a-1), Local Government Code.

A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. Anoffense under this section is a misdemeanor.

CONFLICT OF INTEREST QUESTIONNAIREFor vendor doing business with local governmental entity

Date Received

A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income,other than investment income, from the vendor?

Yes No

B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the directionof the local government officer or a family member of the officer AND the taxable income is not received from thelocal governmental entity?

Yes No

7

Check this box if the vendor has given the local government officer or a family member of the officer one or more giftsas described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1).

Signature of vendor doing business with the governmental entity Date

Name of vendor who has a business relationship with local governmental entity.1

Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated

completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which

you became aware that the originally filed questionnaire was incomplete or inaccurate.)

2

3 Name of local government officer about whom the information is being disclosed.

Name of Officer

Describe each employment or other business relationship with the local government officer, or a family member of theofficer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer.Complete subparts A and B for each employment or business relationship described. Attach additional pages to this FormCIQ as necessary.

4

6

5Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation orother business entity with respect to which the local government officer serves as an officer or director, or holds an

ownership interest of one percent or more.

Revised 11/30/2015Form provided by Texas Ethics Commission www.ethics.state.tx.us

CONFLICT OF INTEREST QUESTIONNAIRE

For vendor doing business with local governmental entity

A complete copy of Chapter 176 of the Local Government Code may be found at http://www.statutes.legis.state.tx.us/Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form.

Local Government Code § 176.001(1-a): "Business relationship" means a connection between two or more partiesbased on commercial activity of one of the parties. The term does not include a connection based on:

(A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or anagency of a federal, state, or local governmental entity;(B) a transaction conducted at a price and subject to terms available to the public; or(C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency andthat is subject to regular examination by, and reporting to, that agency.

Local Government Code § 176.003(a)(2)(A) and (B):(a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if:

***(2) the vendor:

(A) has an employment or other business relationship with the local government officer or afamily member of the officer that results in the officer or family member receiving taxableincome, other than investment income, that exceeds $2,500 during the 12-month periodpreceding the date that the officer becomes aware that

(i) a contract between the local governmental entity and vendor has been executed;or(ii) the local governmental entity is considering entering into a contract with thevendor;

(B) has given to the local government officer or a family member of the officer one or more giftsthat have an aggregate value of more than $100 in the 12-month period preceding the date theofficer becomes aware that:

(i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor.

Local Government Code § 176.006(a) and (a-1)(a) A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationshipwith a local governmental entity and:

(1) has an employment or other business relationship with a local government officer of that localgovernmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A);(2) has given a local government officer of that local governmental entity, or a family member of theofficer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding anygift described by Section 176.003(a-1); or

(3) has a family relationship with a local government officer of that local governmental entity.(a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administratornot later than the seventh business day after the later of: (1) the date that the vendor:

(A) begins discussions or negotiations to enter into a contract with the local governmentalentity; or(B) submits to the local governmental entity an application, response to a request for proposalsor bids, correspondence, or another writing related to a potential contract with the localgovernmental entity; or

(2) the date the vendor becomes aware:(A) of an employment or other business relationship with a local government officer, or afamily member of the officer, described by Subsection (a);(B) that the vendor has given one or more gifts described by Subsection (a); or(C) of a family relationship with a local government officer.

Request for Payroll/Benefits Records File (Please Print)

Date of Request: ________________________________________________________ Employee Name: _______________________________________________________ Employee ID: ________________________ Phone Number: _____________________ I, the above named employee, hereby request for copies of the following documents located in my payroll / benefits file. NOTE: Only records indicated below will be provided. All requests will be completed within 5 to 10 business days or earlier. You will be notified when your request is completed.

(Please check each item being requested)