Applicant Agreement. I understand that if any assistance is needed in setting up equipment or involves computer-related equipment, I will make arrangements with the Adult Services Department at least 48 hours prior to the meeting time. I understand that I will be responsible for and must make good any damage to the library's equipment while it is in my use. I further understand that use of video-projection equip- ment must cease at least 30 minutes before the library closes to allow for shutdown procedures. Signature of person completing this application form Date Please notify the Adult Services Department of any problems with equipment. FOR STAFF USE Date rec'd Time rec'd Rec'd by Date group notified Branch Manager Approved Y N Date approved Calendar Entry
Applicant Agreement. The agent has explained the details of the coverage(s)/benefits and I, the undersigned, acknowledge reading the entire application, including the Claims Funding Agreement and Administrative Services Agreement. The answers I have provided are true and complete. I understand that the terms and conditions herein binds the applicant only when the applicant receives written approval. Full Legal Business Name Signature Name Dated on / /
Applicant Agreement. The agent has explained the details of the coverage(s)/benefits and I, the undersigned, acknowledge reading the entire application, including the Claims Funding Agreement and Administrative Services Agreement. The answers I have provided are true and complete. I understand that the terms and conditions herein binds the applicant only when the applicant receives written approval. The Secure Plans are level-funded plans designed to set your company's maximum financial responsibility. however, you may be subject to financial responsibility greater than your final quoted rates under some circumstances. For example, errors by the administrator or by you may result in additional financial exposure. To minimize such exposure, the administrator and employer must manage this plan in accordance with the standard plan documents. The excess-loss carrier has the right to audit claim and eligibility information prior to funding claims filed under the stop-loss policy. Full Legal Business Name: Signature: Name: Dated on / /
Applicant Agreement. The applicant agrees to abide by the following requirements by initialing each requirement. There are limited exceptions to these requirements. Applicant Initials Applicant Agrees to the Following Requirements
Applicant Agreement. I understand that if any assistance is needed in setting up equipment or involves computer-related equipment, I will make arrangements with the AV Department at least 48 hours prior to the meet- ing time. I understand that I will be responsible for and must make good any damage to the library's equipment while it is in my use. I further understand that use of video-projection equipment must cease at least 30 minutes before the library closes to allow for shutdown procedures. Signature of person completing this application form Date Please notify the Audiovisual Department of any problems with equipment. FOR STAFF USE Date rec'd Time rec'd Rec'd by Date group notified Branch Manager Approved Y N Date approved
Applicant Agreement. The agent has explained the details of the coverage(s)/benefits and I, the undersigned, acknowledge reading the entire application, including the Claims Funding Agreement and Administrative Services Agreement. The answers I have provided are true and complete. I understand that the terms and conditions herein binds the applicant only when the applicant receives written approval. The Secure Plans are level-funded plans designed to set your company's maximum financial responsibility. however, you may be subject to financial responsibility greater than your final quoted rates under some circumstances. For example, errors by the administrator or by you may result in additional financial exposure. To minimize such exposure, the administrator and employer must manage this plan in accordance with the standard plan documents. The excess-loss carrier has the right to audit claim and eligibility information prior to funding claims filed under the stop-loss policy. Full Legal Business Name: Signature: Name: Dated on / / Benefits are not effective until you receive written approval from the program underwriter or administrator. Do not cancel coverage until you receive written notice of approval. Applications will not be underwritten until all required information is submitted. The deposit amount will be returned to you if the Application is denied.
Applicant Agreement. 4.1 agrees that the information in this document is Organization Name true and accurate.
Applicant Agreement. I understand that I will not be allowed to load any software or Internet downloads onto the library’s laptop and that I may not remove the library’s laptop from the library building. I also understand that I will be responsible for and must make good any damage to the computer and associated equipment while it is in my use. Signature Date
Applicant Agreement. I have read the event description and am able to participate in full, if selected. Applicant first and last name (print) Applicant signature Today’s date Parent notification and agreement: I have read the Camp Exec application and description. To the best of my knowledge, my daughter (above) has a clear understanding of the event she has applied for, and, if selected, has my permission to participate. Should my daughter be accepted, I grant Girl Scouts San Diego permission to share the email addresses on this form with other Camp Exec Girl Scouts and executive mentor participants. Any photographs or films taken in which the registered girl appears may be used for promotion or as deemed appropriate by the Girl Scout council, free of any claims on my part. Parent/guardian signature: Today’s date: First and last name: Mailing address: City: State: Zip: Email: 2018 Camp Exec Application Applicant information Home phone (000-000-0000): Cell phone (000-000-0000): Age: Birthdate (mm/dd/yyyy): Number of years in Girl Scouts: Your grade in school, fall 2018 (10th, 11th, 12th): Racial/ethnic background (optional): To help us monitor and promote the participation of girls from various backgrounds, you can choose to provide the following information. This information is for data purposes exclusively and will have no influence on the selection process. □ American Indian □ Asian/Pacific Islander □ Black □ White □ Also of Hispanic origin □ Two or more races □ Other: Parent/guardian information First and last Name: Daytime phone (000-000-0000): Cell phone (000-000-0000): Email: High School and principal info: Name of high school: School address: School city: School zip: Principal’s title (ie: Mr., Mrs., Dr., etc): Principal’s first name: Principal’s last name: Extracurricular activities: Please share information regarding your volunteer, extracurricular and/or community service activities (attach additional sheet if necessary). Please include the name of your activity, duration of involvement, hours per week and a description of the activity including positions and honors, if relevant. (500 characters) Optional: Attach your resume or additional sheet of extracurriculars here. Areas of interest” At Camp Exec, we strive to connect Girl Scouts with professionals who share their strengths and passions. Rank the following areas in order of your level of interest in each (most interested: 1, least interested: 12). □ Culinary arts □ Business □ Engineering and math □ Fine or perf...
Applicant Agreement. I understand that if approved for this program, I will participate fully in the Skills Lab and will attend the entire TARGIT Collaborative Group conference beginning on Friday, September 16th. My conference registration and two nights hotel (Friday & Saturday) will be covered by the conference organizers. I also understand that my travel, including economy airfare, parking, and taxi, will be reimbursed to me up to $500 within 60 days following my participation in this program. I understand that I must submit my receipts for travel in order to receive reimbursement and that I will only be refunded the amount I have spent up to $500. If I cancel for any reason or do not attend the conference as agreed upon, my airfare may not be reimbursed. Applicant Signature Date Institution Approval: I am authorized to approve this application to the 2022 Skills Lab. I confirm that this individual in in good standing with our institution and that academic accommodations will be made for their participation. Signature Title E-Mail Phone Please upload this completed form when completing your online application.
