Check All That Apply. ¨ The undersigned sold the shares identified above pursuant to a registration statement filed under the Securities Act of 1933 (the “Securities Act”).
Check All That Apply. During the past thirty (30) days, I have taken the following medication(s) prescribed to me by a physician: During the past thirty (30) days, I have taken the following nonprescription medications (cough medicine, cold tablets, aspirin, diet medication, nutritional supplements, etc.)
Check All That Apply. ¨ The shares identified above were transferred to a Permitted Affiliate of the Investor. ¨ The shares identified above were transferred to an Affiliate of the Investor. ¨ The shares identified above were transferred to a Person which is not an Affiliate of the Investor in compliance with Section 4.1 or Section 4.2 of the Stockholders Agreement. ¨ The undersigned is currently an Affiliate of the Investor. ¨ The undersigned is providing this Notice to notify the Company that it is no longer a Permitted Affiliate of the Investor. (If this box is checked, please provide the information requested below) The undersigned lost the status of a Permitted Affiliate of the Investor on (enter date) __________________ ¨ The undersigned is providing this Notice to notify the Company that it is no longer an Affiliate of the Investor. (If this box is checked, please provide the information requested below) The undersigned lost the status of an Affiliate of the Investor on (enter date) __________________
Check All That Apply. Pre Tax New Enrollment New Enrollees must enroll with TIAA online. ** Please see below for more details. After Tax (Xxxx) Restart Contribution
Check All That Apply. The undersigned is an individual with a net worth, or a joint net worth together with his or her spouse, in excess of $1,000,000. (In calculating net worth, you may include equity in personal property and real estate, including your principal residence, cash, short-term investments, stock and securities. Equity in personal property and real estate should be based on the fair market value of such property minus debt secured by such property.)
Check All That Apply. Description of service attached. A full position /project description should be attached. List of group participants attached - required if this is a group agreement. Valid driver’s license verified - Check if applicable. Required if volunteer will be driving a government vehicle. International volunteers will need to check with the individual state where their service will be performed, to determine what additional licensing may be required to operate a vehicle. Each situation may be different. Job Hazard Analysis: Recommended be on page one. Parent or Guardian prints name of youth (printed) in box #31 and signs and dates box #32. The parent/guardian should also sign section 34.
Check All That Apply. It is prescribed to
Check All That Apply. The undersigned is an individual with a net worth, or a joint net worth together with his or her spouse, in excess of $1,000,000. (In calculating net worth, you must exclude the value of your primary residence. You may include equity in other personal property and real estate, cash, short-term investments, stock and securities. Equity in personal property and real estate should be based on the fair market value of such property minus debt secured by such property.) ____ (b) The undersigned is an individual that had an individual income in excess of $200,000 in each of the prior two years (2009 and 2008) and reasonably expects an income in excess of $200,000 in the current year (2010); or ____ (c) The undersigned is an individual that had with his/her spouse joint income in excess of $300,000 in each of the prior two years (2009 and 2008) and reasonably expects joint income in excess of $300,000 in the current year (2010). ____ (d) The undersigned is a director, president, vice president in charge of a principal business unit, division or function (such as sales, administration or finance); any other officer who performs a policy making function, or any other person who performs similar policy making functions for Vision Technologies, Inc., a Delaware corporation. ____ (e) The undersigned, either alone or with the undersigned's professional advisor or advisors, has such knowledge and experience in financial and business matters as to be capable of evaluating the merits and risks of acquiring the Shares, and is able to bear the economic risk of the investment in the Shares, including a complete loss of the investment. ____ (f) None of the above.
Check All That Apply. All Tier 1 items and: ☐Local area is on track to meet priority of service requirements for the Adult program; ☐Local area is enrolling participants in Work-based Training (On the Job Training, Apprenticeships, Internships, Work Experiences, etc.) as part of the plan; and ☐Local area is conducting outreach activities to Dislocated Workers, such as participation in Rapid Response or Reemployment Services and Eligibility Assessment (RESEA), across all eligibility categories applicable to the local area and to those with barriers to employment. TIER 3 (
Check All That Apply. All Tier 1 and 2 items and: ☐Local area has a documented, significant need to transfer funds; ☐Local area has collaboration with Partner Agencies demonstrated by co-enrollments and leveraging of multiple funding streams and program referrals; and ☐Local Area has met or is on track to meet its goals for discretionary grants that serve adults and dislocated workers.
