Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 28, 2025

Clerk of the Legislature
Room 2014, State Capitol
PO Box 94604
Lincoln, NE 68509-4604
Phone: (402) 471-2608

For Calendar Year of:

Amended Registration

Lobbyist Registration Fee:
{49-1480.01}

Compensated

$300.00

(If you are a salaried employee of your principal, you are a compensated lobbyist.)

Not Compensated

$15.00

(File a Form E for quarterly report exemption. You are not exempt from the Form D Activity Report.)

PLEASE FILL IN ALL BLANKS

LOBBYIST {49-1480(1)}

Name

Southard, Mike

Office Address (Street, Box, or Route)

55 Washington Street, Suite 800

Permanent Residence (Street, Box, or Route)

3536 Sweet Maggie Lane

City

Brooklyn

State

Zip

11201

City

Naperville

State

Zip

60564

Office Phone

(917) 925-5379

Home Phone

(630) 639-8330

Email Address

msouthard@amplify.com

PRINCIPAL {49-1480(2)}

Name

Amplify Education, Inc.

Office Phone

(917) 925-5379

Office Address (Street, Box, or Route)

55 Washington Street, Suite 800

Official to Whom Lobbyist is Accountable

Jason Rohloff

City

Brooklyn

State

Zip

11201

Nature of Business {49-1480(3)}

Education Curriculum and Assessment

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
12,000.00 Per Year

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} K-12 Education Matters

Description of industry, trade, profession, or interests and groups represented by the principal:
Education; Amplify Education, Inc.

Names and addresses of principal's officers:

Larry Berger, Catherine Mackay, Inna Barmash, Aaron Harnly, Kay Moffett, LaShon Ormond, Paul Sheppard, Alexandra Walsh:
55 Washington Street, Suite 800, Brooklyn, NY 11201

GIVE NAME and ADDRESS of any OFFICIAL in the Legislative or Executive Branch and of any members of any such official's staff or immediate family who is employed by you or by anyone acting on your behalf: {49-1480(8)}

None

I certify that all information presented in this form is accurate to the best of my knowledge.

Mike Southard

Lobbyist Name

Jan 28, 2025

Date