Signature Date. PLEASE INITIAL PAGE 2 Please retain a photocopy of this form for your own records. Terms and Conditions on Reverse Side TERMS AND CONDITIONS
Signature Date. The calendar date when this document is signed by both Parties should be solidified and reported on that day. Each Party should sign this document before a Notary Public who will be able to prove the authenticity of Lessor or Lessee signature provided through the notarization process. (30)
Signature Date. The exact date when this document is signed by both Parties is considered its effective date. This is when the Lessor and Lessee shall supply the proof of signature that each one will comply and benefit from the agreement above. (14)
Signature Date. Once your application has been approved, you will be notified via electronic mail and asked to complete the remainder of the registration process. SOUTHERN STATES UNIVERSITY – LAS VEGAS ENROLLMENT AGREEMENT Last Name First Name Middle Name Social Security Number (if you have one) Home Address (foreign students - this is the address where your I-20 will be mailed) City State Zip Daytime Phone Work Phone Fax Number This agreement is a legally binding instrument when signed by the student and accepted by the University. Your signature on this agreement acknowledges that you have been given reasonable time to read and understand it, and that you have been given: (a) a written statement of the refund policy and (b) a chance to review the SSU General Catalog, including a description of the program of study and all material facts concerning the school which are likely to affect your decision to enroll. The SSU Catalog can be found on SSU’s home page at xxx.xxx.xxx. Upon acceptance, a copy of this agreement shall be sent to you for your records. Southern States University has met the disclosure requirements of Education Code 94810 of the Private and Postsecondary and Vocational Reform Act of January 1, 2002. TRANSFERABILITY OF COURSEWORK The transferability of credits you earn at Southern States University is at the complete discretion of an institution to which you may seek to transfer. Acceptance of the degree or coursework you earn in SSU programs is also at the complete discretion of the institution to which you may seek to transfer. If the credits or degree that you earn at this institution are not accepted at the institution to which you seek to transfer, you may be required to repeat some or all your coursework at that institution. For this reason, you should make certain that your attendance at this institution will meet your educational goals. This may include contacting an institution to which you may seek to transfer after attending SSU to determine if your credits or degree will transfer. Degree and certificate students may request transfer credit under the school’s transfer credit policy as stated in the Catalog. For any transfer credit that is awarded at SSU for previous training or experience, the student will not be asked to pay for the tuition cost of units of the awarded credit. Student Initials NEVADA STUDENTS: Student Refund Policy (State of Nevada Code: NRS 394.449) To cancel enrollment and/or obtain a refund, the student must provide written ...
Signature Date. Designation of Authorized Representative I, the above signed employee do, hereby appoint (please print) (hereinafter “my Authorized Representative” :) to act on my behalf in pursuing a benefit claim specifically pertaining to my Health FSA/ DCAP account(s). My Authorized Representative shall have full authority to act, on my behalf with respect to an initial determination of a Claim, any requests for documents relating to the Claim and any appeal of an adverse determination of a Claim. I am aware that the Standards for Privacy of Individually Identifiable Health Information set forth by the U.S. Department of Health and Human Services (the “Privacy Standards”), govern access to medical information. I understand that in connection with the performance of his/her duties hereunder, my Authorized Representative may receive my Protected Health Information, as defined in the Privacy Standards, relating to the Claim I hereby consent to any disclosure of my Protected Health Information to my Authorized Representative.
Signature Date. Please check if you wish to opt out of any of the described services: I do not wish to have my child care service referred to parents. I do not wish to have my child care service listed on the Child Care Aware® of Missouri online database. I understand I can still be referred through telephone referrals and can have my information added to the online listing at any time if I choose. OFFICE USE ONLY Initials Date WLS ID#
Signature Date. PLEASE INITIAL PAGE 2 Please retain a photocopy of this form for your own records. Terms and Conditions on Reverse Side EXHIBIT SPACE APPLICATION/CONTRACT INITIAL HERE THESE TERMS AND CONDITIONS, AND ALL ATTACHMENTS HERETO, CONSTITUTE THE “LICENSE AGREEMENT.”
Signature Date. Xxxx Xxxxxxxxxx General Secretary The Civil Service Association of Western Australia (Inc) Signed: .................................................................................. ...................................................................
Signature Date. This Agreement shall become binding as of the last signature date of the Settling Parties.
Signature Date. Metropolitan counties contained within the Washington-Arlington-Alexandria, DC-VA-MD are listed below. Washington-Arlington-Alexandria, DC-VA-MD-WV MSA County Name State County Name State County Name State District of Columbia DC Fairfax County VA Alexandria City VA Xxxxxxx County MD Fauquier County VA Fairfax City VA Xxxxxxx County MD Loudoun County VA Falls Church City VA Xxxxxxxxx County MD Prince Xxxxxxx County VA Fredericksburg City VA Xxxxxxxxxx County MD Spotsylvania County VA Manassas City VA Prince George's County MD Xxxxxxxx County VA Manassas Park City VA Arlington County VA Xxxxxx County VA Xxxxxx County VA The Section 3 Resident Certification form should be returned via email or fax to: Xxx Xxxx, Program Manager, fax #000-000-0000 or xxx.xxxx@xxxxxxxxxxxxx.xxx and call 000-000-0000 if questions regarding this form. For more information regarding Section 3 contact: Xxxx Xxxxxxxx, Section 3 Coordinator, at 703-246-5073 or xxxx.xxxxxxxx@xxxxxxxxxxxxx.xxx WARNING Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful false statements or misrepresentation to any Department or Agency of the United States as to matters within its jurisdiction. Virginia Privacy and Freedom of Information Laws Information supplied to the Fairfax County Department of Housing and Community Development (DHCD) will be used for the purpose of verifying eligibility of Businesses and Firms as obtaining Section 3 status under Section 3 of the Housing and Urban Development Act of 1968, 24 CFR Part 135. The information furnished to DHCD will be maintained and in accordance with the Virginia Freedom of Information Act, VA Code Section 2.1-340 through 346.1, as amended, and the Privacy Protection Act of 1976, VA Code Section 2. 1-377 through 386, as amended. Fairfax County is committed to nondiscrimination on the basis of disability in all county programs, services and activities. Reasonable accommodations will be provided upon request. For information, call 000-000-0000, TTY: 711. Schedule M-6 Section 3 Business Certification Plan Please see attached. C o u n t y o f F a i r f a x , V i r g i n i a To protect and enrich the quality of life for the people, neighborhoods and diverse communities of Fairfax County
