Legal Eligibility Form

LEGAL ELIGIBILITY FORM

This Legal Eligibility Form is made effective as of Effective Date: by and between Applicant Name: and Organization Name: (collectively, the "Parties").

RECITALS

WHEREAS, the Applicant seeks to participate in or provide services to the Organization and must demonstrate legal eligibility to perform the activities identified by the Organization; and

WHEREAS, the Organization requires written certifications regarding the Applicant's legal status, age, absence of disqualifying legal impediments, and consent to verification for purposes of determining eligibility; and

WHEREAS, the Parties desire to set forth the Applicant's representations, warranties and authorizations insofar as they pertain to legal eligibility.

NOW THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the Parties agree as follows:

1. DEFINITIONS

For purposes of this Form, capitalized terms not otherwise defined have the meanings set forth in this Section. "Applicant" means the individual or entity identified above. "Organization" means the entity identified above. "Eligibility Criteria" means the requirements set forth in Section 2 of this Form.

2. ELIGIBILITY CRITERIA

The Applicant represents and warrants that, as of the Effective Date, the Applicant satisfies the following criteria:

a) Legal Age: The Applicant is at least eighteen (18) years of age or, if an entity, is duly formed and in good standing. Date of birth (if individual):

b) Lawful Authorization: The Applicant is lawfully authorized to work, provide services, or otherwise engage in the activities described by the Organization under applicable law. Please indicate applicable status (check all that apply):

U.S. Citizen Permanent Resident Authorized Non-Immigrant Other

If Other, please describe:

c) Criminal History: The Applicant has not been convicted of, nor pleaded guilty or nolo contendere to, any felony or any crime involving dishonesty, fraud, or moral turpitude that would be material to the Applicant's performance under this Form. Does the Applicant have any such convictions? No Yes

If Yes, provide a full description including offense, jurisdiction, conviction date, and disposition:

3. REPRESENTATIONS AND WARRANTIES

The Applicant represents and warrants to the Organization as follows: (a) all statements, documents and answers supplied in connection with this Form are true, complete and accurate; (b) there are no pending investigations or administrative proceedings that would materially impair the Applicant's legal eligibility; and (c) the Applicant will promptly notify the Organization in writing of any event or circumstance that would cause any representation or warranty herein to become untrue or incomplete.

4. CERTIFICATIONS, AUTHORIZATIONS AND CONSENTS

The Applicant hereby certifies that the Applicant will provide documentary proof of identity and lawful authorization upon request and authorizes the Organization to verify any information provided in this Form, including but not limited to background checks, criminal records searches, and verification of immigration or employment authorization status to the extent permitted by law. The Applicant acknowledges that refusal to provide requested documentation or consent may result in disqualification.

Authorization to perform background checks: I authorize I do not authorize

5. NOTICE CONTACTS

All formal notices required under this Form shall be in writing and delivered to the addresses provided below. Either Party may change its notice address by written notice to the other Party in accordance with this section.

6. INDEMNIFICATION

The Applicant agrees to indemnify, defend and hold harmless the Organization and its officers, directors, employees and agents from and against any and all liabilities, claims, damages, losses, costs and expenses (including reasonable attorneys' fees) arising out of any misrepresentation, omission, or breach of this Form by the Applicant, or from the Applicant's failure to meet the Eligibility Criteria.

7. REMEDIES

In addition to any other remedy available at law or in equity, the Organization may immediately suspend or terminate any relationship with the Applicant if the Organization reasonably determines that the Applicant does not meet the Eligibility Criteria, or if any representation or warranty herein is false or misleading in any material respect.

8. GOVERNING LAW; SEVERABILITY; ENTIRE AGREEMENT

This Form shall be governed by and construed in accordance with the laws of the state selected by mutual agreement of the Parties or, absent such agreement, the laws of the state in which the Organization maintains its principal place of business, without regard to conflict of laws principles. If any provision of this Form is held invalid or unenforceable, the remaining provisions will remain in full force and effect. This Form constitutes the entire agreement of the Parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements and understandings, whether written or oral.

9. AMENDMENTS; WAIVER; COUNTERPARTS

Any amendment or modification of this Form must be in writing and signed by both Parties. No waiver of any provision of this Form will be effective unless in writing and signed by the Party against whom enforcement is sought. This Form may be executed in counterparts, each of which will be deemed an original, and all of which together constitute one instrument.

10. ATTESTATIONS

The Applicant attests under penalty of perjury that the information provided in this Form is true and correct to the best of the Applicant's knowledge and that the Applicant understands that knowingly providing false information may subject the Applicant to civil and criminal penalties.

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