Participant Information My address is: My Social Security Number is:
Estimated Number of Participating Households Approximately 6,460. This figure is based on loans with unpaid principal balances ranging from $200,000 to $400,000 with an average funding of $5,000.00.
Participant Agreement I understand that as a condition for participating in the Program I must comply with the Program’s rules and standards of conduct and follow all reasonable direction of the Program Staff. Failure to comply with the Program’s rules and standards of conduct or failure to comply with the reasonable direction of Program Staff may result in my being dismissed from the Program. Participant Signature: Date: PARENT/LEGAL GUARDIAN AGREEMENT I understand that my child will be subject to the rules and standards of conduct of the Program, Valdosta State University and the University System of Georgia. I further understand that my child’s violation of the rules and standards of conduct or failure to comply with the reasonable direction of Program Staff may result in my child’s dismissal from the Program. I accept responsibility for all costs associated with removing my child from the Program, including but not limited to transportation costs to return the Participant home. I understand that Dismissed Participants are not eligible for a refund of any fees or expenses. Parent/Guardian Signature: Date:
Participant Signature Ratification, Acceptance(A), Approval(AA), Accession(a)
Code of Basic Working Conditions and Human Rights Xxxxx is committed to providing a safe and secure working environment and the protection and advancement of basic human rights in its worldwide operations. In furtherance of this commitment, Xxxxx has adopted a Code of Basic Working Conditions and Human Rights setting out in detail the measures it takes to ensure this commitment is fulfilled. This code may be downloaded at xxxxx://xxx.xxxxxx.xxx/principles/xxxxx-xxxxxx.xxxx. Xxxxx strongly encourages Seller to adopt and enforce concepts similar to those embodied in the Boeing Code, including conducting Seller’s operations in a manner that is fully compliant with all applicable laws and regulations pertaining to fair wages and treatment, freedom of association, personal privacy, collective bargaining, workplace safety and environmental protection. Seller shall include the substance of this clause, including this flowdown requirement, in all subcontracts awarded by Seller for work under this Contract.
Child or Elder Care Emergencies Leave without pay, compensatory time or paid leave may be granted for child or elder care emergencies.
File Management and Record Retention relating to CRF Eligible Persons or Households Grantee must maintain a separate file for every applicant, Eligible Person, or Household, regardless of whether the request was approved or denied.
Rollovers of Xxxx Elective Deferrals Xxxx elective deferrals distributed from a 401(k) cash or deferred arrangement, 403(b) tax-sheltered annuity, 457(b) eligible governmental deferred compensation plan, or federal Thrift Savings Plan, may only be rolled into your Xxxx XXX.
TELEPHONE & EMERGENCY PROCEDURES If you need to contact Xxxxxxxxx Xxxxx between sessions, please leave a message at the answering service (000-000-0000 and your call will be returned as soon as possible. Xxxxxxxxx Xxxxx checks her messages a few times during the daytime only, unless she is out of town and will return your call within 24 hours. If an emergency situation and you are in a crisis situation, and Xxxxxxxxx Xxxxx cannot be reached, you may call 911, or 24-Hour Crisis Hotlines – National 1-800-273-TALK (8255) National Suicide Prevention Lifeline, Suicide/Crisis Hotlines of Maricopa 0-000-000-0000 or 000-000-0000, or go immediately to your local hospital emergency room. Please do not use email or faxes for emergencies. Xxxxxxxxx Xxxxx may be with a client, out of the office or on vacation and may be unable to check her email or faxes daily. PAYMENTS & INSURANCE REIMBURSEMENT: Clients are expected to pay at initial appointment an intake assessment fee of $200 per 90 minute session (for individual) or $250 for 90 minute session per couple or family. Clients are expected to pay the standard fee of $120.00 per 45 minutes (individual), 150 per 60 for (individual) or $150.00 per 45 minutes for (couple) and 175 per 60 minutes (couple and family) session; at the end of each session or at the end of the month unless other arrangements have been made. Telephone conversations, site visits, writing and reading of reports, consultation with other professionals, release of information, reading records, longer sessions, travel time, etc. will be charged at the same rate, unless indicated and agreed upon otherwise. Please notify Xxxxxxxxx Xxxxx if any problems arise during the course of therapy regarding your ability to make timely payments. Clients who carry insurance should remember that professional services are rendered and charged to the clients and not to the insurance companies. Unless agreed upon differently, Xxxxxxxxx Xxxxx will provide you with a copy of your receipt on a monthly basis, which you can then submit to your insurance company for reimbursement, if you so choose. As was indicated in the section, Health Insurance & Confidentiality of Records, you must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues/conditions/problems, which are dealt with in psychotherapy, are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage. If your account is overdue (unpaid) and there is no written agreement on a payment plan, Xxxxxxxxx Xxxxx can use legal or other means (courts, collection agencies, etc.) to obtain payment.
Domestic Partners; Spouses; Gender Discrimination If the Contract Amount is $100,000 or more, Contractor certifies that it is in compliance with PCC 10295.3, which places limitations on contracts with contractors who discriminate in the provision of benefits regarding marital or domestic partner status.
