Region 16 Education Service Center 188950 BOARD MEMBERS ELECTION AND APPOINTMENT BBB (EXHIBIT) The ESC will use the following forms for Board member elections: Exhibit A: Oath of Office—1 page Exhibit B: Application for Place on Ballot—2 pages Exhibit C: Sample Ballot—1 page Exhibit D: Current and Former Board Members and Executive Directors—2 pages DATE ISSUED: 11/11/2016 LDU 2016.01 BBB(EXHIBIT)-X 1 of 1 Region 16 Education Service Center 188950 BOARD MEMBERS ELECTION AND APPOINTMENT BBB (EXHIBIT) EXHIBIT A OATH OF OFFICE STATEMENT OF OFFICER “I, ________________________________, do solemnly swear (or affirm) that I have not directly or indirectly paid, offered, promised to pay, contributed, or promised to contribute any money or thing of value, or promised any public office or employment for the giving or withholding of a vote at the election at which I was elected or as a reward to secure my appointment or confirmation, whichever the case may be, so help me God.” Tex. Const. Art. XVI, Sec. 1(b) OATH OF OFFICE “I, __________________________________, do solemnly swear (or affirm), that I will faithfully execute the duties of the office of member of the Board of Directors of the Region 16 Education Service Center of the state of Texas, and will to the best of my ability preserve, protect, and defend the Constitution and laws of the United States and of this state, so help me God.” Tex. Const. Art. XVI, Sec. 1(a) DATE ISSUED: 11/11/2016 LDU 2016.01 BBB(EXHIBIT)-X 1 of 1 Region 16 Education Service Center 188950 BOARD MEMBERS ELECTION AND APPOINTMENT BBB (EXHIBIT) EXHIBIT B APPLICATION FOR PLACE ON BALLOT Request is made that my name be placed upon the official ballot for Place _____ for the Board of Directors election to be held by Region 16 Education Service Center at the first regular or special Board meeting in the month of April in each school district within the region. My occupation is: The county of my residence is: My post office address is: Length of residency in state: _______ years; in above-named region: ______ years. I am over 21 years of age and I am not disqualified or ineligible to hold the above-mentioned office and meet all qualifications therefore. Please place my name on the official ballot as follows: Candidate’s name (print or type) Candidate’s signature THE STATE OF TEXAS COUNTY OF _______________________________________________ Before me, the undersigned authority, on this day personally appeared _________________ _______________________________________________, known to me to be the person whose name is subscribed to the foregoing instrument in writing, and acknowledged to me that he or she executed the same for the purpose therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE, this the __________________ day of ________________________________, ______. Notary Public _________________ County State of Texas LOYALTY AFFIDAVIT OF CANDIDATES FOR PUBLIC OFFICE I, _______________________________________, of the county of ___________________, state of Texas, being a candidate for the office of __________________________________ do solemnly swear I will support and defend the Constitution and laws of the United States and of the state of Texas. Candidate’s signature THE STATE OF TEXAS COUNTY OF _______________________________________________ Subscribed and sworn to before me at _________ this ____________ day of ________________________, ______. , Texas (Vea al Iado reverso para la traducción al español) DATE ISSUED: 11/11/2016 LDU 2016.01 BBB(EXHIBIT)-X 1 of 2 Region 16 Education Service Center 188950 BOARD MEMBERS ELECTION AND APPOINTMENT BBB (EXHIBIT) SOLICITUD PARA POSICION EN BOLETA Por la presente solicito que mi nombre sea incluído en la boleta oficial para el Lugar #_____ de la elección de Administrador que se llevará a cabo en la Región 16 del Centro Regional de Servicios Educacionales (Region 16 Education Service Center) en la junta reglamentaria o especial del consejo que se reunirá en el mes de abril en cada distrito escolar de la región. Mi ocupación es: Mi edad es de años. El condado de mi residencia es Mi dirección postal es: Residencia en el estado: ___________ años; en la región arriba mencionada ______ años. No estoy descalificado ni soy ineligible a ocupar el oficio arriba mencionado y reuno todos los requisitos del mismo. Favor de incluir mi nombre en la boleta oficial como sigue: El nombre del candidato en letra de bloque o a máquina Firma del candidato EL ESTADO DE TEXAS CONDADO DE _______________________________________________ Ante mí, la autoridad que subscribe, en este día se presentó personalmente ____________ ________________________________________________, conocido por mí como la persona cuyo nombre subscribe por escrito el documento anterior, y certifica ante mí haber ejecutado el mismo para el propósito que en él se cita. DADO BAJO MI FIRMA Y SELLO DE OFICIO, este día ____________________________ de _____________________________ de __________. Notario Público Condado de El Estado de Texas ACTA NOTARIAL DE LEALTAD DE CANDIDATO A PUESTO PUBLICO Yo, _________________________________, del Condado de _______________________, Estado de Texas, siendo candidato para el puesto de _______________________________ juro solémnemente, que apoyaré y defenderé la Constitución y leyes de los Estados Unidos y del Estado de Texas. Firma del candidato EL ESTADO DE TEXAS CONDADO DE _______________________________________________ Subscribe y jura ante mí en _________ este día ____________ de ________________________, _____. , Texas (See reverse side for English translation) DATE ISSUED: 11/11/2016 LDU 2016.01 BBB(EXHIBIT)-X 2 of 2 Region 16 Education Service Center 188950 BOARD MEMBERS ELECTION AND APPOINTMENT BBB (EXHIBIT) EXHIBIT C SAMPLE BALLOT OFFICIAL BALLOT EDUCATION SERVICE CENTER REGION XVI EACH BOARD MEMBER MAY VOTE FOR ONE PERSON FOR EACH POSITION DATE ISSUED: 11/11/2016 LDU 2016.01 BBB(EXHIBIT)-X 1 of 1 Region 16 Education Service Center 188950 BOARD MEMBERS ELECTION AND APPOINTMENT BBB (EXHIBIT) EXHIBIT D BOARD OF DIRECTORS CURRENT MEMBERSHIP Name and Residence Place 1 2 3 4 5 6 7 Don Bednorz (Panhandle) David Schaeffer (Dimmitt) Lawrence Bussard (Dumas) Vacancy Kathleen Morris (Amarillo) Darrell L. Garrison Sherry McCavit (Pampa) Year First Elected Year Elected to Present Term Term Number Present Term Expires 2005 2015 5 2018 2009 2015 3 2018 2010 2016 2 2019 1992 2014 8 2017 2016 2016 1 2019 2000 2015 6 2018 Executive Director: Ray Cogburn FORMER BOARD MEMBERS Name Residence Years Served Mrs. Marion Hill * Borger 1969–1981 Ernest Langley _* Hereford 1967–1973 Charles Lutz _* Amarillo 1967–1973 Bill J. Montgomery* Amarillo 1974–1980 R. C. Porter Spearman 1981–1989 Andy Rogers _ Childress 1967–1969 Charles M. Rogers _* Amarillo 1967–1973 Robert Sanders Amarillo 1980–1983 Ray A. Snead, Jr. Dalhart 1980–1983 Aubrey L. Steele _* Pampa 1967–1990 DATE ISSUED: 11/11/2016 LDU 2016.01 BBB(EXHIBIT)-X 1 of 2 Region 16 Education Service Center 188950 BOARD MEMBERS ELECTION AND APPOINTMENT BBB (EXHIBIT) M. E. Cleavinger, Jr. _* Amarillo 1967–1981 Jerry Carlson Pampa 1990–1991 Joe Gidden _ Canyon 1967–1994 Raymond White * Hereford 1973–1994 R. C. Neely, Jr.* Amarillo 1981–1995 Colleen Hamilton Pampa 1993–2000 Dennis Newton Hereford 1994–2003 Kenneth Laycock Canyon 1994–2004 Harold Bob Bennett Hart 2004–2009 E. R. Bell* Stratford 1983–2010 Zoel Allen, D.D.S. * Perryton 1987–2013 Gary Schneck Borger Ky Sherrod Amarillo 1995–2016 Michael Lee Booker 2014–2016 John Bass Dr. Darrell L. Garrison Jim Holmes Dr. Kenneth Laycock Huelyn Laycock * Dr. Emmitt Smith * – PESO 2013 FORMER EXECUTIVE DIRECTORS 2004–2015 1994–2004 1990–1994 1974–1990 1967–1974 1965–1967 _ Original Board Member * Deceased DATE ISSUED: 11/11/2016 LDU 2016.01 BBB(EXHIBIT)-X 2 of 2