PLEASE ANSWER THE FOLLOWING QUESTIONS Sample Clauses

PLEASE ANSWER THE FOLLOWING QUESTIONS. Does your child take any Foreign language courses in Grades 6, 7 or 8? If yes, please check off one or more of the following two language selections. Does your child take band or chorus in Grades 6-8? Yes French Yes No Spanish No If yes, please check off one or both of the following two course selection. Does your child participate in athletics? (for Grades 6-12) Band Yes Chorus No ***For Students Who Participate in Sports*** NEWARK CENTRAL SCHOOL DISTRICT ATHLETIC DEPARTMENT FORM FOR GRADES 7-12 FAX # 000-0000 Previous School Attended: Student’s address while attending the above school Street and Number City, State, Zip With whom did student reside at this address? Father Mother Guardian 000 XXXX XXXXXX XXXXXX NEWARK, NEW YORK 14513 (000) 000-0000 FAX (000) 000-0000 Date: XXXXXXX X. XXXX NEWARK CENTRAL SCHOOL DISTRICT Superintendent of Schools XXXXXX X. XXXXX Assistant Superintendent Curriculum & Instruction XXXXXX X. XXXX Assistant Superintendent Business XXXXX XXXXXX Director of Pupil Services NEWARK CENTRAL SCHOOL DISTRICT REGISTRATION FORM AUTHORIZATION FOR RELEASE OF INFORMATION I hereby request that Newark Central School receive a transcript of the health/immunizations and scholastic records for my son/daughter from: NAME OF PREVIOUS SCHOOL: ADDRESS: PHONE: ( ) FAX: ( ) STUDENT NAME: GRADE: D.O.B.: SIGNATURE OF PARENT/GUARDIAN: ** These records should include ** ** P☜LEASE SIGN ** ⮚Transcripts of grades (including grades in progress up to the date of withdrawal*) *Please provide numerical equivalent if alphabetical grades are reported* ⮚Test scores, including Competency Test Scores/State Assessments ⮚Health/Immunization Information ⮚Guidance Information, Special Education, 504 Records ⮚Evaluation Reports (Psychological, Related Services, etc.) ⮚AIS Records ⮚Instructional Support Team Interventions and Notes ⮚ ESL Service Records Newark Senior High School – Grades 9 – 12 Attn: XxxxXxxx Xxxxxxxxx, Building Secretary 000 Xxxxxxx Xxxxxx, Newark, NY 14513 Tel: (000) 000-0000; Fax: (000) 000-0000 Newark Middle School – Grades 6 – 8 Attn: Xxxxx Xxxx, Building Secretary 000 Xxxxxxx Xxxxxx, Newark, NY 14513 Tel: (000) 000-0000; Fax: (000) 000-0000 X. X. Xxxxxx Intermediate School – Grades 3 – 5 Attn: Xxxx Xxxxx, Building Secretary 000 Xxxx Xxxxxx Xxxxxx, Newark, NY 14513 Tel: (000) 000-0000; Fax: (000) 000-0000 Xxxxxxx School – Grades K-2 Attn: Xxxxxx Xxxxxxx, Building Secretary 000 Xxxx Xxxxx Xxxxxx, Xxxxxx, XX 00000 Tel: (000) 000-0000; Fax: (000) 000-0000...
Sample 1
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PLEASE ANSWER THE FOLLOWING QUESTIONS a. During the previous twelve (12) months, have you entered into contracts, including the present contract, bid or proposal, with the City of Berkeley for a cumulative amount of $100,000.00 or more? YES NO If no, this Contract is NOT subject to the requirements of the LWO, and you may continue to Section II. If yes, please continue to question 2(b).
Sample 1Sample 2
PLEASE ANSWER THE FOLLOWING QUESTIONS. If yes to any of the following questions, please attach a detailed information sheet Have you ever had a state license or certification to practice your profession relinquished, denied, limited, revoked or suspended, either voluntarily or involuntarily? YES NO Have any investigations or disciplinary actions ever been initiated and/or are any now pending against you by a state license board, certification agency or professional organization? YES NO Have you ever been convicted of a felony or misdemeanor relating to the practice of your profession, other health care related matters, third-party reimbursement, violence, controlled substance violation, or anything other than a minor traffic violation? YES NO Have you ever had hospital privileges denied, revoked, suspended, or voluntarily surrendered? YES NO Have you ever had disciplinary action or been denied membership/renewal in any professional society organization? YES NO Have you ever been the subject of investigation by or been suspended, sanctioned, or otherwise restricted from participating in any private, federal or state health insurance program (ie: Medicare or Medicaid)? YES NO If yes to any of the following questions, please attach a detailed information sheet. Please include name of court in which suit was filed, caption and docket number of case, name and address of attorney defending you, and any other relevant details. Have you ever been named as a defendant in any criminal proceeding? YES NO Has your professional liability insurance ever been terminated by action of an insurance company? YES NO If yes, state when and by what company. Have you ever been denied professional liability coverage? YES NO If yes, state when and by which company. Have you ever been rated in a higher than average risk class for your profession, or had an additional premium imposed upon you because of your claims history? YES NO Have any professional liability suits been filed against you? YES NO Have any professional liability suits been filed against you of which are presently pending? YES NO Have any judgments been made against you in a professional liability case/claim, or have you entered into any settlements? YES NO If yes to any of the following questions, please include a sheet of detailed information. Are you able to perform all physical and mental functions, with or without accommodation, necessary to provide patient care services for which you are seeking clinical privileges? YES NO If no, please explain. Ar...
Sample 1
PLEASE ANSWER THE FOLLOWING QUESTIONS. Your answers will be held in the strictest of confidence. (Circle one) Yes No 1. Do you currently use illegal drugs? Yes No 2. Have you ever been convicted of the illegal manufacture, sale or Possesion of drugs? Yes No 3. Have you ever been convicted of a criminal offense? (Conviction of a crime is not an automatic bar to employment. Lords of Soccer will consider the nature of the offense, the date, and the relationship between the offense and the position applied for.) Yes No 4. Have you ever been adjudged liable for civil penalties or damages involving sexual or physical abuse of children? Yes No 5. Are you subject to any court order involving sexual or physical abuse of a minor, including, but not limited to a domestic order or protection? I understand that the Lords of Soccer camps may deny employment to any person who answers any of the above questions, numbered 1-5,
Sample 1
PLEASE ANSWER THE FOLLOWING QUESTIONS. 1. Do you have a Doing Business As (DBA) account? If so, please provide the Legal and DBA names. Legal Name DBA
Sample 1
PLEASE ANSWER THE FOLLOWING QUESTIONS. 1. Are you under indictment or information (an information is a formal accusation of a crime made by a prosecuting attorney) in any court for a crime for which a judge could imprison you for more than one (1) year? YES □ NO □
Sample 1

Related to PLEASE ANSWER THE FOLLOWING QUESTIONS

  • Interview Questions Explanation Why do you want to be a Board member? What specific skills would you bring to the Board? Please give specific examples of your ability in interpersonal relationships and teamwork. What do you see as the role of a Board member? What have you done to prepare yourself for the challenges of being a Board member? Interview questions are at the Board's sole discretion. This list is not exhaustive, but it may help the Board tailor its questions toward finding a candidate who will approach Board membership with a clear understanding of its demands and expectations along with a constructive attitude toward the challenge. The Board may also want to consider allowing an equal amount of time for each interview. Please describe your previous community or non-profit experiences. What areas in the district would you like to see the Board strengthen? See IASB's Recruiting School Board Candidates, available at: xxx.xxxx.xxx/xxxxxxxx/xxxxxxxxxx.xxx A prospective candidate to fill a vacancy may raise other specific issues that the Board will want to cover during an interview. What is your availability to meet the time, training commitments, and other responsibilities required for Board membership? Describe what legacy you would like to leave behind. Conduct interviews with candidates (interviews may occur in closed session pursuant to 5 ILCS 120/2(c)(3)). Interview Plan Explanation In each interview, the Board President will: Introduce Board members to the candidate at the beginning of the interview. Describe the Board's interview process, selection process, and ask the candidate if he or she has questions about the Board's process for filling a vacancy by appointment. Describe the District's philosophy or mission statement. Describe the vacancy for the candidate by reviewing the: (1) qualifications, and (2) general duties and responsibilities of the Board and the Board members, including fiduciary responsibilities, conflict of interest, ethics and gift ban, and general Board member development. Begin asking the interview questions that the Board developed. Ask the candidate whether he or she has any questions for the Board. Thank the candidate and inform the candidate when the Board expects to make a decision and how the candidate will be contacted regarding the Board's decision. The Board President will lead the Board as it interviews prospective candidates. See Board policy 2:110, Qualifications, Term, and Duties of Board Officers. The president presides at all meetings. 105 ILCS 5/10-13. The Board may also want to consider allowing an equal amount of time for each interview. Fill vacancy by a vote during an open meeting of the Board before the 60th day (105 ILCS 5/10-10, amended by P.A. 101-67, eff. 1-1-20). Assist the appointed Board member in filing his or her statement of economic interest (5 ILCS 420/4A-105(c). Announce the appointment to District staff and community. Announcement Explanation The Board appointed [appointee's name] to fill the vacancy on the Board. The appointment will be from [date] to [date]. The Board previously established qualifications for the appointee in a careful and thoughtful manner. [Appointee's name] meets these qualifications and has demonstrated the willingness to accept the duties and responsibilities of a Board member. [Appointee's name] brings a clear understanding of the demands and expectations of being a Board member along with a constructive attitude toward the challenge. The contents of the appointment announcement and length of time it is displayed are at the Board's sole discretion. The Board may want to consider announcing the appointment during its meeting and also by posting it in the same places that it posted the vacancy announcement. See Board policy 8:10, Connection with the Community. Administer the Oath of Office and begin orientation. Guidelines Explanation See Board policy 2:80, Board Member Oath and Conduct. Each individual, before taking his or her seat on the Board, must take an oath in substantially the form given in 105 ILCS 5/10-16.5. See Board policy 2:120, Board Member Development, and 2:120-E, Guidelines for Serving as a Mentor to a NewSchool Board Member. Orientation assists new Board members to learn, understand, and practice effective governance principles. See the IASB Foundational Principles of Effective Governance, available at: xxx.xxxx.xxx/xxxxxxxxxx_xxxxx.xxx. Inform IASB of the newly appointed Board member's name and directory information. DATED : December 16, 2019 Ottawa THSD 140

  • Renewal Notice; Notification of Changes Subject to governing law, XOOM can renew this Agreement with new or revised Terms. XOOM will send you written notice at least (30) days before the end of the Term. The notice will specify the date by which you must advise XOOM if you do not want to renew your Agreement. If you do not advise XOOM by the specified date, this Agreement will automatically renew at the fixed rate or variable rate then in effect in accordance with the notice. XOOM reserves the right, with fifteen (15) days’ notice, to amend this Agreement to adjust its service to accommodate any change in regulations, law, tariff or other change in procedure required by any third party that may affect XOOM’s ability to continue to serve you under this Agreement.

  • Conflict of Interest Questionnaire Requirement Vendor agrees that it has looked up, read, and understood the current version of Texas Local Government Code Chapter 176 which generally requires disclosures of conflicts of interests by Vendor hereunder if Vendor:

  • Reasonable Suspicion Testing The Employer may, but does not have a legal duty to, request or require an employee to undergo drug and alcohol testing if the Employer or any supervisor of the employee has a reasonable suspicion (a belief based on specific facts and rational inferences drawn from those facts) related to the performance of the job that the employee:

  • Conflict of Interest Questionnaire - Form CIQ No response Do not upload this form unless you have a reportable conflict with TIPS. There is an Attribute entitled “Conflict of Interest Questionnaire Requirement” immediately followed by an Attribute entitled “Conflict of Interest Questionnaire Requirement – Form CIQ – Continued.” Properly respond to those Attributes and only upload this form if applicable/instructed. If upload is required based on your response to those Attributes, the Conflict of Interest Questionnaire – Form CIQ must be downloaded from the “Attachments” section of the IonWave eBid System, reviewed, properly completed, and uploaded at this location. Vendor’s Warranties, Terms, and Conditions (Supplemental Vendor Information Only)

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