Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Sep 17, 2018

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

$200.00

(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

Dominguez, Alexandra

Office Address (Street, Box, or Route)

P.O. Box 10691

Permanent Residence (Street, Box, or Route)

City

Tallahassee

State

Zip

32302

City

State

Zip

Office Phone

(850) 391-4200

Home Phone

Email Address

stateoutreach@excelined.org

PRINCIPAL {49-1480(2)}

Name

Excellence in Education National, Inc., d/b/a Excellence in Education in Action

Office Phone

(850) 391-4200

Office Address (Street, Box, or Route)

P.O. Box 10691

Official to Whom Lobbyist is Accountable

J. Alex Kelly

City

Tallahassee

State

Zip

32302

Nature of Business {49-1480(3)}

Non-Profit Education Advocacy

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
4,500.00 Per Year

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Matters relating to K-12 education including college and career pathways.

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

Names and addresses of principal's officers:

Patricia Levesque, John E. Bush, F. Philip Handy, Zachariah P. Zachariah
P.O. Box 10691, Tallahassee, Fl 32302

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)}

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

Dominguez, Alexandra

Lobbyist Name

Sep 17, 2018

Date