Common use of Program Agreement Clause in Contracts

Program Agreement. As the program representative, I confirm that the early childhood program information provided on Page 1 of this Award Planning Agreement is correct and accurate to the best of my knowledge. Additionally, I, as a representative of the program: • Have discussed the program’s planned use of scholarship funds to cover or supplement family payments for services with the parent(s) or legal guardian(s) of the child(ren) included on this Award Planning Agreement and provided the parent/guardian with a copy. • Have included enrollment details that are accurate and current as of the signature date below. • Will submit this completed form with program and parent signatures (or completed “Alternative to Signature” option entries) to the Area Administrator within 10 business days of the child’s first date of attendance for which the scholarship will be used and within three business days of completing this form. Follow the directions outlined in the Area Administrator section at the end of this form. • Will provide the scholarship payment history when parents/guardians ask. • Will comply with payment policies for both the Early Learning Scholarships Program and the Area Administrator as outlined in the Program Participation Agreement and in the State Early Learning Scholarships Policy Manual. • Will provide the parent/guardian with a copy of the Program Participation Agreement if requested. Program Representative Name: Program Role or Title of Representative: Signature: Date Signed (MM/DD/YYYY): Parent Agreement: I, as the parent of the included child(xxx) receiving the Early Learning Scholarship–Pathway I, confirm that the information provided in this document is true to my knowledge. Additionally, I acknowledge and agree to the following: • The scholarship can only pay one eligible program at a time. If my child attends two programs, the scholarship may only be used at one program. • The scholarship cannot be used to reimburse the program for costs already paid by the parent/guardian. • I will contact my Area Administrator and the program if I stop services with the program named in this document. • Absent days over 25 will not be covered by scholarships and charges must be paid at my own expense. o For a Medical Exemption, I may contact the Area Administrator for details. o If I am a teen parent, my family is experiencing homelessness or my child(ren) in xxxxxx care or child protective services have court or other assigned visitation or reunification efforts, I may contact the Area Administrator for an exemption if I anticipate absences of more than 25 days. • A change in my selected program’s Parent Aware Status could impact the program’s ability to receive Early Learning Scholarships as well as the amount of my scholarship award. • An Early Childhood Screening is required for children ages 3 or older who are receiving a Pathway I scholarship within 90 days of first attending a selected program. For children in xxxxxx care, the county/ tribal case manager must provide authorization prior to scheduling the screening. • If I currently receive Child Care Assistance (CCAP), I am advised to keep it because the scholarship does not impact my eligibility to receive CCAP. • My Early Learning Scholarship – Pathway I will not cover the following: o Charges beyond the scholarship award amount o Charges after the scholarship award has ended o Some fees such as late pay, late pick up, or optional services • I should contact my Area Administrator if I have questions about what is eligible to be paid for by the Early Learning Scholarship–Pathway I scholarship. Parent/Guardian Name (Please print): 🞎 Option A: Signature Parent/Guardian Signature: Date Signed (MM/DD/YYYY): 🞎 Option B: Alternative to Signature Program Representative reviewed all content of this Award Planning Agreement with the parent/guardian using the communication method below. The parent/guardian agreed to the use of their child’s (children’s) scholarship award as outlined in this document. Communication details: Method: Phone Email Other: Date: Time:

Program Agreement. As the program representative, I confirm that the early childhood program information provided on Page 1 of this Award Planning Agreement is correct and accurate to the best of my knowledge. Additionally, I, as a representative of the program: • Have discussed the program’s planned use of scholarship funds to cover or supplement family payments for services with the parent(s) or legal guardian(s) of the child(renchild(xxx) included on this Award Planning Agreement and provided the parent/guardian with a copy. • Have included enrollment details that are accurate and current as of the signature date below. • Will submit this completed form with program and parent signatures (or completed “Alternative to Signature” option entries) to the Area Administrator within 10 business days of the child’s first date of attendance for which the scholarship will be used and within three business days of completing this form. Follow the directions outlined in the Area Administrator section at the end of this form. • Will provide the scholarship payment history when parents/guardians ask. • Will comply with payment policies for both the Early Learning Scholarships Program and the Area Administrator as outlined in the Program Participation Agreement and in the State Early Learning Scholarships Policy Manual. • Will provide the parent/guardian with a copy of the Program Participation Agreement if requested. Program Representative Name: Program Role or Title of Representative: Signature: Date Signed (MM/DD/YYYY): Parent Agreement: I, as the parent of the included child(xxx) receiving the Early Learning Scholarship–Pathway I, confirm that the information provided in this document is true to my knowledge. Additionally, I acknowledge and agree to the following: • The scholarship can only pay one eligible program at a time. If my child attends two programs, the scholarship may only be used at one program. • The scholarship cannot be used to reimburse the program for costs already paid by the parent/guardian. • I will contact my Area Administrator and the program if I stop services with the program named in this document. • Absent days over 25 will not be covered by scholarships and charges must be paid at my own expense. o For a Medical Exemption, I may contact the Area Administrator for details. o If I am a teen parent, parent or my family is experiencing homelessness or my child(ren) in xxxxxx care or child protective services have court or other assigned visitation or reunification effortshomelessness, I may contact the Area Administrator for an exemption if I anticipate absences of more than 25 days. • A change in my selected program’s Parent Aware Status could impact the program’s ability to receive Early Learning Scholarships as well as the amount of my scholarship award. • Starting July 1, 2024, Early Learning Scholarships – Pathway I can only be used at programs with a Three- or Four-Star Parent Aware rating. • An Early Childhood Screening is required for children ages 3 or older who are receiving a Pathway I scholarship within 90 days of first attending a selected program. For children in xxxxxx care, the county/ county/tribal case manager must provide authorization prior to scheduling the screening. • If I currently receive Child Care Assistance (CCAP), I am advised to keep it because the scholarship does not impact my eligibility to receive CCAP. • My Early Learning Scholarship – Pathway I will not cover the following: o Charges beyond the scholarship award amount o Charges after the scholarship award has ended o Some fees such as late pay, late pick up, or optional services • I should contact my Area Administrator if I have questions about what is eligible to be paid for by the Early Learning Scholarship–Pathway I scholarship. Parent/Guardian Name (Please print): 🞎 Option A: Signature Parent/Guardian Signature: Date Signed (MM/DD/YYYY): 🞎 Option B: Alternative to Signature Program Representative reviewed all content of this Award Planning Agreement with the parent/guardian using the communication method below. The parent/guardian agreed to the use of their child’s (children’s) scholarship award as outlined in this document. Communication details: Method: Phone Email Other: Date: Tim: Form Return Instructions Please note that our offices are closed to the public and our staff are working remotely from home. Staff can be reached at the phone number below from 8am to 4:30pm Monday-Thursday and 8am to noon on Friday. Northland Foundation 000-000-0000e:

Program Agreement. As the program representative, I confirm that the early childhood program information provided on Page 1 of this Award Planning Agreement is correct and accurate to the best of my knowledge. Additionally, I, as a representative of the program: • Have discussed the program’s planned use of scholarship funds to cover or supplement family payments for services with the parent(s) or legal guardian(s) of the child(renchild(xxx) included on this Award Planning Agreement and provided the parent/guardian with a copy. • Have included enrollment details that are accurate and current as of the signature date below. • Will submit this completed form with program and parent signatures (or completed “Alternative to Signature” option entries) to the Area Administrator within 10 business days of the child’s first date of attendance for which the scholarship will be used and within three business days of completing this form. Follow the directions outlined in the Area Administrator section at the end of this form. • Will provide the scholarship payment history when parents/guardians ask. • Will comply with payment policies for both the Early Learning Scholarships Program and the Area Administrator as outlined in the Program Participation Agreement and in the State Early Learning Scholarships Policy Manual. • Will provide the parent/guardian with a copy of the Program Participation Agreement if requested. Program Representative Name: Xxxxx Xxxxx Program Role or Title of Representative: Director Signature: Date Signed (MM/DD/YYYY): 7/15/2021 Parent Agreement: I, as the parent of the included child(xxx) receiving the Early Learning Scholarship–Pathway I, confirm that the information provided in this document is true to my knowledge. Additionally, I acknowledge and agree to the following: • The scholarship can only pay one eligible program at a time. If my child attends two programs, the scholarship may only be used at one program. • The scholarship cannot be used to reimburse the program for costs already paid by the parent/guardian. • I will contact my Area Administrator and the program if I stop services with the program named in this document. • Absent days over 25 will not be covered by scholarships and charges must be paid at my own expense. o For a Medical Exemption, I may contact the Area Administrator for details. o If I am a teen parent, parent or my family is experiencing homelessness or my child(ren) in xxxxxx care or child protective services have court or other assigned visitation or reunification effortshomelessness, I may contact the Area Administrator for an exemption if I anticipate absences of more than 25 days. • A change in my selected program’s Parent Aware Status could impact the program’s ability to receive Early Learning Scholarships as well as the amount of my scholarship award. • Starting July 1, 2024, Early Learning Scholarships – Pathway I can only be used at programs with a Three- or Four-Star Parent Aware rating. • An Early Childhood Screening is required for children ages 3 or older who are receiving a Pathway I scholarship within 90 days of first attending a selected program. For children in xxxxxx care, the county/ county/tribal case manager must provide authorization prior to scheduling the screening. • If I currently receive Child Care Assistance (CCAP), I am advised to keep it because the scholarship does not impact my eligibility to receive CCAP. • My Early Learning Scholarship – Pathway I will not cover the following: o Charges beyond the scholarship award amount o Charges after the scholarship award has ended o Some fees such as late pay, late pick up, or optional services • I should contact my Area Administrator if I have questions about what is eligible to be paid for by the Early Learning Scholarship–Pathway I scholarship. Parent/Guardian Name (Please print): Xxxx Test Please print the Parent/Guardian Name if using Option A or Option B 🞎 Option A: Signature Parent/Guardian Signature: Date Signed (MM/DD/YYYY): �🞎✔x � Option B: Alternative to Signature Program Representative reviewed all content of this Award Planning Agreement with the parent/guardian using the communication method below. The parent/guardian agreed to the use of their child’s (children’s) scholarship award as outlined in this document. Communication details✔ : Method: Phone Email Other: Date07/17/2021 : Tim: 10:00 am Form Return Instructions Northland Foundation 000-000-0000 or 0-000-000-0000 000 X Xxxxxxxx Xxxxxx, Xxxxx 000 website: xxx.xxxxxxxxxxxx.xxx Duluth, MN 55802 email: xxxx@xxxxxxxxxxxx.xxx Our office is open 8 a.m. to 4:30 p.m. Monday-Thursday and 8 a.m. to noon Friday Please note that our offices are closed to the public and our staff are working remotely from home. Family Payment Worksheet Early Learning Scholarships – Pathway I This worksheet is an optional planning tool for calculating family payments. All entries should be a best estimate. Please note: • Early Learning Scholarships Program policy does not require families to make payments to the program serving their child prior to fully spending the amount of their child’s Early Learning Scholarship award. • The early childhood program serving the awarded child may have internal policies that require on-going payments be made alongside scholarship payments if the scholarship award will not cover the estimated total of tuition and fees at the program for the remaining period of the award. • In the event that there are changes to the family’s payment plan with the program during the scholarship award period, this form should be revisited by the family and program again if it is helpful. Attends 3 days/week Attends 5 days/week Example CHILD 1 CHILD 2 CHILD 3 CHILD 4 Child Name Xxxxxx Xxx Hourly Example Daily Example Monthly Examplee:

Program Agreement. As the program representative, I confirm that the early childhood program information provided on Page 1 of this Award Planning Agreement is correct and accurate to the best of my knowledge. Additionally, I, as a representative of the program: • Have discussed the program’s planned use of scholarship funds to cover or supplement family payments for services with the parent(s) or legal guardian(s) of the child(renchild(xxx) included on this Award Planning Agreement and provided the parent/guardian with a copy. • Have included enrollment details that are accurate and current as of the signature date below. • Will submit this completed form with program and parent signatures (or completed “Alternative to Signature” option entries) to the Area Administrator within 10 business days of the child’s first date of attendance for which the scholarship will be used and within three business days of completing this form. Follow the directions outlined in the Area Administrator section at the end of this form. • Will provide the scholarship payment history when parents/guardians ask. • Will comply with payment policies for both the Early Learning Scholarships Program and the Area Administrator as outlined in the Program Participation Agreement and in the State Early Learning Scholarships Policy Manual. • Will provide the parent/guardian with a copy of the Program Participation Agreement if requested. Program Representative Name: Program Role or Title of Representative: Signature: Date Signed (MM/DD/YYYY): Parent Agreement: I, as the parent of the included child(xxx) receiving the Early Learning Scholarship–Pathway I, confirm that the information provided in this document is true to my knowledge. Additionally, I acknowledge and agree to the following: • The scholarship can only pay one eligible program at a time. If my child attends two programs, the scholarship may only be used at one program. • The scholarship cannot be used to reimburse the program for costs already paid by the parent/guardian. • I will contact my Area Administrator and the program if I stop services with the program named in this document. • Absent days over 25 will not be covered by scholarships and charges must be paid at my own expense. o For a Medical Exemption, I may contact the Area Administrator for details. o If I am a teen parent, my family is experiencing homelessness or my child(ren) in xxxxxx care or child protective services have court or other assigned visitation or reunification efforts, I may contact the Area Administrator for an exemption if I anticipate absences of more than 25 days. • A change in my selected program’s Parent Aware Status could impact the program’s ability to receive Early Learning Scholarships as well as the amount of my scholarship award. • An Early Childhood Screening is required for children ages 3 or older who are receiving a Pathway I scholarship within 90 days of first attending a selected program. For children in xxxxxx care, the county/ tribal case manager must provide authorization prior to scheduling the screening. • If I currently receive Child Care Assistance (CCAP), I am advised to keep it because the scholarship does not impact my eligibility to receive CCAP. • My Early Learning Scholarship – Pathway I will not cover the following: o Charges beyond the scholarship award amount o Charges after the scholarship award has ended o Some fees such as late pay, late pick up, or optional services • I should contact my Area Administrator if I have questions about what is eligible to be paid for by the Early Learning Scholarship–Pathway I scholarship. Parent/Guardian Name (Please print): 🞎 Option A: Signature Parent/Guardian Signature: Date Signed (MM/DD/YYYY): 🞎 Option B: Alternative to Signature Program Representative reviewed all content of this Award Planning Agreement with the parent/guardian using the communication method below. The parent/guardian agreed to the use of their child’s (children’s) scholarship award as outlined in this document. Communication details: Method: Phone Email Other: Date: Tim: Form Return Instructions Staff can be reached at the phone number below from 8am to 4:30pm Monday-Thursday and 8am to noon on Friday. Northland Foundation 000-000-0000e: