Agreement of Services. YES: This affirmation confirms timely and meaningful consultation did occur for the program design and is equitable with respect to eligible private school children.
Agreement of Services. Name: Phone: Email Address: Coaching Service Level: I agree to contract the services of [YOUR COMPANY NAME] Coaching and Consulting Group, LLC, [YOUR NAME] or one of [HIS/HER] associates, to provide coaching services for the purpose of addressing my business and personal projects, objectives, and goals. I understand that the coaching relationship is based upon my agenda and this relationship is most effective when I communicate fully. If at any time I feel the coaching relationship is not working as desired, I agree to work toward re-designing the relationship. Also, I agree that [YOUR COMPANY NAME] Coaching and Consulting Group, LLC is free from any liability or actions that may be related to any comments or suggestions made by [YOUR NAME], or any of [HIS/HER] associates. _____________________________________ Signature (client) _____________________________________ Date
Agreement of Services. ☒ I agree with the above listed services, AND I authorize [Regional Center] to purchase the services agreed upon for the implementation of the IPP ☐ The team did not agree on the following services: Select service(s) AND ☐ I agree, as discussed with my team, to hold an IPP meeting on [ ]. This will be held within 15 days, or later, to review the items not agreed upon at today’s meeting. I may waive this second meeting if my concerns regarding the Services and Supports are resolved to my satisfaction before the end of the 15-day period [Welfare and Institutions (W & I) Code section 4646(h)]. The approximate start date of existing services will be the date of the IPP, unless otherwise indicated. New services will require time to initiate and complete referrals and may take longer to begin. Are there exceptions to settings requirements? ☐ Yes ☒ No ☐ I am in agreement with the exceptions to the Community Settings rule described in the following category/area(s): [Select a category/area] Acknowledgments: ☒ I have been provided a statement of the services and supports the regional center purchased during the last year [W & I Code section 4648(h)]. ☒ I have discussed and shared information related to any current or anticipated future needs with my Service Coordinator for resource development [W & I Code section 4648(e)]. ☒ [Regional Center] will conduct IPP/PCSP meetings, as necessary, in response to my achievement or changing needs. This may happen once a year if I’m enrolled in the Medicaid Waiver or no less often than once every three years if I’m not enrolled. My Service Coordinator will be responsible to monitor this plan. I am aware that I may call my planning team at any time by contacting my Service Coordinator. I would like to receive a copy of the IPP: ☒ Electronically ☒ Printed copy in the mail The following information was discussed: ☒ Self-Direction Self-Direction provides an opportunity for individuals and families to manage the supports and services they elect to receive, including who provides the services and how services are provided. This is supported by the Service Coordinator through the person-centered planning process. Types of Self-Direction may include: • Self-Determination Program: Allows participants the opportunity to have more control in developing their service plans and selecting service providers to better meet their needs. Participants develop a budget and spending plan to purchase services and goods from qualified service provide...
Agreement of Services. MVPN agrees to use Xxxxxx Xxxxx as their Business Consultant as set forth below.
Agreement of Services. 2.1.1 It is contemplated that from time to time during the term of this Agreement, Contractor may be requested by NGS (through its duly authorized representatives) to perform survey services utilizing its EM Technology anywhere on the North American Continent. However the execution of this Agreement is not intended nor will it be construed to obligate NGS to award any specific services to Contractor or, to obligate the Contractor to provide any specific services to NGS, unless as provided otherwise under this Agreement.
Agreement of Services. After reading and acknowledging the above information, the signatures below serves as an agreement between and Xxxxx Xxxxxx, CDWF, LMFT, to begin the therapy process. I understand that fees are due at the time of service and I understand the confidentiality and privacy matters as outlined above. Furthermore, I understand that I may discontinue services at anytime for any reason. By signing below, I willingly consent to therapy services via teletherapy with Xxxxx Xxxxxx, LMFT. Print Signature Date Phone: Email: DOB: Address:
Agreement of Services. Name: Lady Xxxxxxxxx Xxxxxx Phone: 000- 000-0000 Email Address: xxxxxxxxxxxx@xxxxx.xxx Executive Coaching Service Level: VisionOne™ Professional Coaching Program I agree to contract the services of Signature Living, Inc., Xxxxx Xxxxxxx, to provide coaching services for the purpose of addressing my personal projects, objectives, and goals. I understand that the coaching relationship is based upon my agenda and this relationship is most effective when I communicate fully. If at any time I feel the coaching relationship is not working as desired, I agree to work toward re- designing the relationship. Also, I agree that Signature Living, Inc. is free from any liability or actions that may be related to any comments or suggestions made by Xxxxx Xxxxxxx. Client(s) Signature____________________________________________________________________ Date Signature Living, Inc. Date Signature Living, Inc. | The InspirePreneur™ Inspiring Transformation For You 000 Xxxxxxxxxx Xxxxxxx, Xxxxx 000 Xxxx Xxxx Xxxxx, Xxxxxxx 00000 C: 561-351-9338
Agreement of Services. For any and all services performed, inclement weather may cause for a service to be delayed and or canceled. In the event this occurs you will be contacted and informed by a technician and/or by his or her manager. The client will pay Eastern Med no later than 30 days upon receipt of invoice. If payment is not received within the 30 day net policy a 1.5% charge will be applicable. In the event the account becomes 60 days past due, all services will be suspended until the account has been paid in full. Should you have any questions or concerns regarding this Agreement of Services please contact your Eastern Med representative by calling (000) 000-0000. The laws of the State of New York shall govern this agreement. This agreement is executed in the State of New York. Signature / Title - Xxxxxxxxxx County Print Name - Xxxxxxxxxx County Date
Agreement of Services. Name: Phone: Email Address: State (Ex: NY): Emergency Contact (Name/Relationship/ Phone Number): Package: Soulpreneurship 1:1 Support + Strategy Call I agree to contract the services of Moonful Mama (Soulpreneur Studio), Xxxxxxx X’Xxxxxx to provide mentorship services for the purpose of addressing my Soulpreneurship objectives and goals. I understand that the mentorship relationship is based upon my agenda and this relationship is most effective when I communicate fully. If at any time I feel the mentorship relationship is not working as desired, I agree to work toward re-designing the relationship. Also, I agree that Xxxxxxx X’Xxxxxx is free from any liability or actions that may be related to any comments or suggestions made by Xxxxxxx X’Xxxxxx, or any of her associates. Signature (client) Date MOONFUL MAMA
Agreement of Services. Sub-contractor confirming acceptance of the above terms and conditions: Signed Print Name Date For Office Use Only For and on behalf of CAG (UK) Limited Signed Print Name Date xxx.xxxxxx.xx.xx Paying In Agreement This is to verify that I, ________________ (name here), understand the following:
