Attestation Form. If Consultant is an individual or sole proprietor, Consultant agrees to complete the United States Citizenship Attestation Form as provided by City and attach it to the Agreement.
Attestation Form. I hereby request that the District of Columbia Addiction Professional Consortium Certification Board (DCAPC) grant the certificate issued to me based on the following assurances and documentation:
Attestation Form. As indicated above, I have elected to use shares of Pacific Financial Corporation common stock that I already own to pay the Aggregate Purchase Price of the Option (and withholding taxes, if applicable).
Attestation Form. As indicated above, I have elected to use shares of CytoDyn common stock that I already own to pay the Aggregate Purchase Price of the Option.
Attestation Form. All students who are not included on the student list must fill out this Attestation Form stating they are a Training Partnership Student. Class and Module Number: Instructor Full Name: Student Last 4 SSN: Employer: Student Phone: (Include area code) If my instructor says there is room in the class, I may choose to stay but understand that I may not receive credit and/or may not be paid for my time. Student Name: Student Signature: An Incident is an unusual event that occurs surrounding instruction delivery and disrupts the class delivery process. Reported incidents should clearly outline all details relevant to the incident, the events contributing to the incident, the actions taken by the network provider in response to the incident, and if the incident was resolved or if additional actions are required. A Complaint is a statement that a situation is unsatisfactory or unacceptable. Learners with complaints should be encouraged to contact the MRC via phone at l-866-371-3200 or via email at XXX@xxxx000.xxx. Instructors with complaints should submit an Incident Report to the network PPC to escalate the issue to the Training Partnership. Incident Reporting Form The SEIU Healthcare NW Training Partnership is committed to ensuring that students, faculty, administrators, and staff spend their days in a safe and healthy environment. Together, we will make every effort to protect you r identity and the confidentiality of this statement. However, we may need to contact you for further information as we investigate the incident. We are asking everyone to use this confidential form to report any concerns, incidents or potential incidents relating to: Personal Injury/sickness Disruptive /Inappropriate behavior Violence Disparagement of religion(s) or (including harm to self or others) engagement of religious activities Bullying political activity drugs, or weapons Sexual harassment Other Are you: (circle one) Staff Instructor Student Student’s Employee: Date of Incident: Time of Incident: Place of Incident: (classroom, other) Person(s) directly involved in incident: Witness to Incident: Description Of Incident (Please provide specific details below and if necessary you may attach another sheet): Email: Phone: I acknowledge that I have read and understand the above statements. I certify that all statements made on this form are true and complete. I authorize the Training Partnership to disclose the information I provide as necessary in pursuing the investigation. Plea...
Attestation Form. As indicated above, I have elected to use shares of BBSI common stock that I already own to pay the Aggregate Option Price of the Option.
Attestation Form. School shall complete an Attestation Form for all Program Participant pursuant to Exhibit C, attached hereto, and incorporated herein by reference. Completed form will be sent to the Hospital Authority.
Attestation Form. United States Citizenship Attestation Form
Attestation Form. Contemporaneously with the delivery of each financial statement required by Sections 7.5(a) and (b) above, an attestation form substantially in the form of Exhibit "B" attached hereto and made a part hereof, signed by an authorized officer of Borrower and attesting to the truthfulness and accuracy of the information set forth in such financial statements.
Attestation Form. Sales Tax Exemption Form 13 The herein above mentioned Contract Documents form this Contract and are a part of the Contract as if hereto attached. Said documents which are not attached to this document may be viewed at: xxxxxxx.xx.xxx - Keyword: Bid - Awarded or Closed bids. This Contract contains the complete and entire Contract between the parties and may not be altered or amended except in writing executed, making specific references to this Contract, by a duly authorized officer of the Contractor and by a duly authorized official of the County. The Contractor and the Owners hereby agree that all the terms and conditions of this Contract shall be binding upon themselves, and their heirs, administrators, executors, legal and personal representatives, successors, and assigns.
