SAN DIEGO CITY SCHOOLS
Administrative and Legislative Services Office

CONFLICT OF INTEREST DISCLOSURE FORM

Each principal, ASB advisor or teacher sponsoring or participating in a tour or trip paid by students is required to complete this form.

Field Trip and Date ___________________________________________________________________

Name __________________________________________________

Position __________________________________________________

Location __________________________________________________

Indicate below whether you or a member of your family is currently receiving (or has received during the last five years) any gratuity, commission, rebate, or thing of value from any travel agency or travel promoter. Plane fares, hotel accommodations, etc., provided in return for chaperoning should be listed and would be considered reasonable and acceptable.

_________________________________________     ________________________
(Signature)                                                               (Date)