Form Center

2. Pursuant the City of Watauga Code of Ordinances all employees shall follow Division 2-Ethics with regard to receipt of gifts.
4. Division 2-Ethics
   City of Watauga Code of Ordinances-Division 2 - Ethics
6. Are you reporting a:*
   -- Select One --GiftFavorGratuityDonation
7. If reporting a donation, was the City Manager notified?*
   -- Select One --YesNo
8. Was a Donation Agreement Completed and Submitted to the CSO?*
   -- Select One --YesNo
9. Name of the person or entity who provided the gift, favor, gratuity or donation?*
11. Date gift, favor, gratuity or donation was received?*
    Date gift, favor, gratuity or donation was received?
12. Is the gift, favor, gratuity or donation valued at over $25.00?*

    1. Yes
    2. No
13. If the gift, favor, gratuity, donation is valued over $25, please provide the estimated value below:*
15. Description of the gift, favor, gratuity or donation received?*
16. How was the gift, favor, gratuity or donation utilized or applied?*
    -- Select One --Kept for selfUsed for City Purposes-within DepartmentUsed for City Purposes- outside DepartmentShared with other employeesDonated
17. If used for other departments, please select department(s) below:*

    1. Human Resources
    2. Police
    3. Finance
    4. Fire
    5. Planning & Eco Dev
    6. Public Works
    7. Library
    8. Administration/CSO
    9. Parks & Rec
19. I hereby affirm that the information submitted electronically on this form is true and correct and based on my personal knowledge.

    By submitting this form and entering your name below you are digitally signing and verifying that the information provided is accurate and belongs to you.

22. Name of employee submitting form:*
23. Department *
24. Email Address*
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field