FormW-4 (2010) Complete all worksheets that apply. However,youmayclaimfewer (orzero) allowances. Forregularwages, withholdingmust be based on allowances

Purpose. CompleteFormW-4so that your youclaimed and may not be a flatamountoremployer can withholdthe correct federal income percentage of wages.tax from your pay. Considercompletinga new Head of household. Generally, you may claimFormW-4 each year and whenyour personalor head of household filingstatus on your tax1inancialsituationchanges. return only ifyou are unmarried and pay moreExemption from withholding. Ifyou are than 50% of the costs of keeping up !\homeexempt, complete only lines 1, 2, 3, 4, and 7 for y~~rse~fa':l~ your dependent(s) or otherand sign the formto validate it. Yourexemption quahfyi~g mdlVlduals.See Pu~. 501, . .for 2010 expires February 16, 2011. See Exemptl~ms,St~ndard £>,eduction,and FlhngPub. 50S, Ta)(Withholdingand Estimated Tax. Information, for information.Note. You cannot claim exemption from Tax credits. You can tak.e projected taxwithholding if (a)your income exceeds $950 credits into account in figuring your allowableand includes more than $300 of unearned number of withholding allowances. Credits forincome (forexample, interest and dividends) child or dependent care expenses and the.and (b) another person can claim you as a child tax credit may be claimed using thedependent on his or her tax return. Personal Allowances Worksheet below. SeeBasic instructions. Ifyou are not exempt. Pub. 919~How I:?0I Adju~t MyTax .

. complete the Personal Allowances Worksheet Withholding, fo~In!orma~lonon .convertlngbelow. The worksheets on page 2 further adjust your other credits Into withholding allowances.your withholding allowances based on itemized Nonwage income. If you have a large amountdeductions, certain credits, adjustments to of nonwage income, such as interest orincome, or two-eamers/multiple jobs situations. dividends, consider making estimated tax

Personal Allowances Worksheet (Keep for your records..

A Enter "1" for yourself if nooneelsecanclaimyouasadependent. . . . . . . .

i_yOU are single and. have only one job; or

)BEnter "1" if: - You are married. have only cine job. and your spouse does not work; or

. Your wagesfrom a secondjob or your spouse's wages (or the total of both)are $1,5QO orless.. .

CEnter "1" for your spouse. But; you may choose to enter "-0-" if you are married and have either a working spouse ormore than one job. (Entering "-0-" may help you avoid having too little tax withheld.) . . . .

D Enter number of dependents (other than your spouse or yourself) you will claim on your tax retumE Enter "1" if you will file as head of household on your tax return (see conditions under Head of household above)FEnter "1" if you have at least $1.800 of child or dependent care expenses for which you plan to claim a credit

(Note. Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.)G Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information.

- If yourtotal incomewill be less than $61,000 ($90,000ifmamed),enter "2" for each eligiblechild;then less "1" if you havethreeor more eligiblechildren.- If your total income will be between $61.000 and $84.000 ($90.000 and $119,000 if married).enter "1" for each eligible

child plus "1" additional if you have six or more eligible children. GH Add lines Athrough G and enter total here. (Note. This may be differentfrom the numberof exemptionsyou claim on your tax return.) ~ H

For accuracy,

{

-If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductionscomplete all and Adjustments Worksheet on page 2.worksheets . Ifyouhavemorethanonejob oraremarriedandyouandyourspousebothwork and the combined earnings from all jobs exceedthat apply. $18,000($32,000if mamed), see the Two-EamerslMultiple Jobs Worksheet on page 2 to avoid having too little tax withheld.

- If neither of the above situations applies; stop here and enter the number from line H on line 5 of Form W-4below.

payments using Form 1040-ES, Estimated Taxfor Individuals. Otherwise, you may oweadditional tax. If you have pensi.onor annuityincome, see Pub. 919 to find out if you shouldadjust your withholding on Form W-4 or W-4P.

Two earners or multiple jobs. If you have aworking spouse or more than one job, figurethe total number of allowances you are entitiedto claim on all jobs using worksheets from onlyone Form W-4. Your withholding usually willbe most accurate when all allowances areclaimed on the Form W-4 for the highestpaying job and zero allowances are claimed onthe others. See Pub. 919 for details.

Nonresident alien. If you are a nonresidentalien, see Notice 1392, SupplementalFormW-4 Instructions for Nonresident Aliens, beforecompleting this form.

Check your withholding. After your Form W-4takes effect, use Pub. 919 to see how theamount you are having withheld compares toyour projected total tax for 201 O. See Pub.919, especially ifyour.eamings exceed$130,000 (Single) or $18~,OOO (Married).

A

B

CD

EF

;............................... -...Cut here and give Form W-4 to your employer. Keep the top part for your records.

FormW-4 008 No. 1545-0074

Employee's Withholding Allowance CertificateDepartmentof \he TreasuIY ~ Whether you are entiUedto ciaim a certain number of allowancesor exemptionfrom withholdingIs'InternalRevenueSeNice subject to review by the IRS. Your employer may be required to send a copy of this fonn to the IRS.

Type or printyour first nameand middleinitial. Last name . 2 YoUr&oclalsecurity number

3 0 Single 0 Mar{ied 0 Married, but withhold at higher Single rate.Nate. If roamed,bullegaDyseparated,orspouseIsa nonresidentafien,checkthe"Single"box.

4 If your last name differs from that shown on your social security card,~b~1UY:t:e..X9j1 must call 1'-800-772-1213 for a replacement card; ~ 0

I _ I

5 Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) .6 Additional amount, if any. you want withheld from each paycheck . . . . . . . . .7 I claim exemption from withholding for 2010, and I certify that I meet both of the following conditions for exemption.

., ,_~ ~~ !...I.asty.eacJ..b.ad.tuigl1Un 11rAflloO-ll.f.aIUedp""r IOGOme..tax withheld oor-.ause..Lhad no tAX liability..anl. This year I expect a refund of all federal income tax withheld because I expect to have no tax liabilitv.If ou meet both conditions, write -Exem t" here. . . . . . . . . . . . . . ~ 7

Under penalties of perjury, I declare that I have eJ<3mined this certificate and to the best of my knowledge and belief, II is true, correct, and complete.

Home address (number and street or rural route)

City or town, state, and ZIP code

.. Employ~i9natute(Form is not valid unless you sign It.) ~

8 Employer's name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.)

Date ~

9 Office.code(optional)110 Employerlden\ificationnuniber (ElN)

For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 102200 Form W-4 (2010)

Department cI Hcmeland SecurityU.S. Citizenshipand IrrrnigrationServices

OMS No. 1615-0047; Expires06l3O/09

Form 1-9,EmplOjrnentEligibility Verification

Readinstructionscarefullybeforecompletingthisform. TheInstructionsmustbeavailableduringcompletioncI thisform.

ANTI-DISCRIMINATION NOTICE: It is illegaltodi!aiminateagainstwork-authorize:i individuals Empl9YersCANNOT§)Edfy which dcx:ument(s)they will ooooptfran an empl<¥ee. The rEfusalto hirean individual because the dcx:umentshave afUture expiration date may als:>coostitufeillegal di!aimination.

Soction 1. Empl<¥eeI nfamation and Verification (TobecorrplEtoo and sgnoo by errpIoyre el thetime€mp/oyrrent be;jins.)Rint Nane: Last Arst MiddleInitiafI MaidenName

Address (STeel Name and Number) Date of Birth (molth/day/year)

City State Zip Code Soci af Security #

I amawarethatfederailawprOJidesforimpri!a1ment and/or finesfor fal~statementsoru~d fal~dcx:umentsin coone:::tionwith thecompletion d this form.

I attest, under penafty of perjury, that I am (check one of the following):

o A citizen of the United Sti'tes

o A noncitizen national of the United St3es (see instructions)

o A lawful permanent resident (Alien #)

o An afien authorized to work (Alien # or Admission#)

until (expiration date, if applicable -month'daylyeat)

Date (molth/day/year)Employee's Signature

Prepar er and/or Translator Certification (Tobe compIded and sgned if Section 1 is prePared by a person otbs- than the employee) I affd, mdfl"penalfyofperjury, that I have assisted in thecorrpletion of this form and that to thebe&ofmyknowfedgetheinformationisfrueand correct.

Repa-er's'Transiator'sSignature Riot Nane

Address (STeel Name and Number, City. Safe, Zip Code) Date (morth/daylyear)

Soction 2. EmplC¥er Re.riew and Verification (To be corrp/fioo and sgnoo by erp/OYfT. Examne one cIocurrent from Uffil A ORexam ne one dOCl.J1'rel7tfrom U ffilB and one from Uffil C, as Iiffilooon the rwerre of this form and re:::ord the title, nurrber, andexpireliondele, if any. ofthedocument(s).)

List A OR

I

'

.,

,

~

ListS AND ListCDocurrent title:

Issuing authority:

Docurrent #:

Expiration Date (if any):

Docurrent #:

Expiration Date (if any):

CERTIFICATION: I attest, under penaltycl perjury, that! have examined thedocument(s) presented by the above-named employee,thatthe above-listed documerrt(s)appear to be ~ulne and to relate to the employeenamed, that the employee began employment on(rmnthlday/ye8r) and that to the best d my kn<M4edgethe employeeIs authorized to \WI'kIn the United States. (Stateemployment agendesmay omit the date the employee began employment)Signaureof ErqJIoyerorAuthorizedRepresertative I RintNane Title

Business or Organization Name am Address (STeel Name and Number, City. Sate, Zip Code) Date (morthldaylyear)

Se::tioo3-=-upaatingana~eJeilfiarna1(TODeiXiTplfiOO aoosgniifljyfiijj!oYfj:)A.Ne.vName(ifapplicable) I B.DateofRehire(molth/daylyear)(ifapplicable)

C. If ernp/oyee'sprevious grant of work authorization hasexpired,provi dethe informati on belr:/.N-for the document that establishescUrrenternp/oyrrent authorization.

Documaot Title: Docurrent #: Expiration Date (if any):

I attest, under penalty of perjury, that to the bet of my kOOlolofedge,this employee is authorized to work in the United States, and ifthe employee premtectdocument(s), thedocumalt(s) I have examined appear to be genuine and to relate to the individual. .

Signaure of Employer or Authorized Representative Date (molt/Vday/year)

Form 1-9 (Rev. CJ2ICJ2IOO) N Page 4

2009-2010 PEIMS Data StandardsAppendix F: Ethnicity and Race Reporting Guidance

Exhibit 1A

Texas Education AgencyTexas Public School Student/Staff Ethnicity and Race Data Questionnaire

The United States Department of Education (USDE) requires all state and local educationinstitutions to collect data on ethnicity and race for students and staff. This information is usedfor state and federal accountability reporting as well as for reporting to the Office of Civil Rights(OCR) and the Equal Employment Opportunity Commission (EEOC).

School district staff and parents or guardians of students enrolling in school are requested toprovide this information. Ifyou decline to provide this information, please be aware that theUSDErequires school districts to use observer identificationas a last resort for collecting thedata for federal reporting.

Please answer both parts of the following questions on the student's or staff member's ethnicityand race. United States Federal Register (71 FR 44866)

Part 1. Ethnicitv: Is the person Hispanic/Latino? (Choose only one)

D Hispanic/Latino -A person of Cuban, Mexican, Puerto Rican, South or Central American, orother Spanish culture or origin, regardless of race.

D Not Hispanic/Latino

Part 2. Race: What is the person's race? (Choose one or more)

D American Indian or Alaska Native -A person having origins in any of the original peoplesof North and South America (including Central America), and who maintains a tribal affiliationor community attachment.

D Asian -A person having origins in any of the original peoples of the Far East, SoutheastAsia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan,Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

D Black or African American -A person having origins in any of the black racial groups ofAfrica.

D Native Hawaiian or Other Pacific Islander -A person having origins in any of the originalpeoples of Hawaii, Guam, Samoa, or other Pacific Islands.

D White -A person having origins in any of the original peoples of Europe, the Middle East, orNorth Africa.

Student/Staff Name (please print) (Parent/Guardian)/(Staff) Signature

Student/Staff Identification Number Date

Texas Education Agency - March 2009

F.5

I