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Genesis donor program anatomic... Medical Education & Research Institute Genesis Donor Program Anatomical Gift Authorization Form I, being of sound mind and body, do hereby freely (Type or print full name of Donor First, Middle,

Bluebiz benefit administrator... BlueBiz Benefit Administrator Authorization Form BlueBiz provides a single, secure way to access Blue Cross and Blue Shield of Florida (BCBSF) web-based capabilities. Complete and sign the appropriate

Authorization to release recor... Office of the General Counsel. FERPA Authorization Form. OGC-SF-2006-02 Revised 03.10.08. Page 1 of 1. Note: Modification of this Form requires approval of ...

New york city department of ed... NEW YORK CITY DEPARTMENT OF EDUCATION AUTHORIZATION FOR SIPP EXPENDITURE NON-EMPLOYEE PAYMENT REQUEST FORM For use in conjunction with the on-line SIPP Program Type or use black ballpoint pen. PRINT legibly to insure prompt payment. INSTRUCTIONS FOR COMPLETING FORM This form is to be used by non-Department of Education employees to record their attendance at Department of Education planning meetings or program activities that provide for payments to such individuals. Fixed rates for reimbursement have been established as a guide only and may be found in appropriate SOPM and/or memoranda on this topic* Actual invoices or individual receipts may be submitted in lieu of fixed rate reimbursement if actual expenses are higher than those suggested provided prior written approval is obtained from the Executive Director of the Division of Financial Operations. Regions may establish rates less than those suggested if no documentation is provided* The non-employee is responsible for completing information in Sections 1 through 3. In the box for Name of Program enter the specific name of the program such as School Based Management Parent Involvement Program School Wide Projects etc* The principal or other approving officer completes Section 4. The District/Central Business Office completes Section chairperson or to the Department of Education official responsible for the activity principal teacher-in-charge program coordinator etc* at each meeting to verify attendance. The completed form is to be sent to the Central or Region Office for review and payment processing through the On-Line SIPP System* In general allow five 5 to ten 10 days for the check to be issued and received through the mail* NOTE Consult program guidelines to determine if documentation supporting expenses is required* SECTION 1 REGION SCHOOL NAME OF PROGRAM SOCIAL SECURITY NUMBER NAME OF NON-EMPLOYEE Type or print legibly Apartment Number MAILING ADDRESS Number and Street CITY STATE ZIP CODE DATE OF MEETING MM DD YY MEETING PERIOD Hours Example 8 00 pm to 9 00 pm FROM TO TOTAL HOURS PAYMENT RATE OR ACTUAL EXPENSE OFFICIAL S SIGNATURE I certify that I have met the obligations as a member of the Enter name of program committee or activity and request the appropriate reimbursement of which will cover my actual expenses. SIGNATURE OF NON-EMPLOYEE DATE I approve this expenditure certifying that it is necessary for the conduct of the educational or administrative program and is in accordance with the rules and regulations of the Department of Education and applicable funding source guidelines. SIGNATURE OF PRINCIPAL OR APPROVING OFFICER FOR REGION/CENTRAL OFFICE USE ONLY FUNDS ARE AVAILABLE CHARGE TO ACTIVITY CODE LOCATION CODE QUICK CODE DATE Revised October 2004 OBJECT CODE AMOUNT Entered On-Line ENTERED BY AUTHORIZED BY COPY 1 FMC/Region Office COPY 2 School/Program Coordinator COPY 3 Non-Employee. INSTRUCTIONS FOR COMPLETING FORM This form is to be used by non-Department of Education employees to record their attendance at Department of Education planning meetings or program activities that provide for payments to such individuals. Fixed rates for reimbursement have been established as a guide only and may be found in appropriate SOPM and/or memoranda on this topic* Actual invoices or individual receipts may be submitted in lieu of fixed rate reimbursement if actual expenses are higher than those suggested provided prior written approval is obtained from the Executive Director of the Division of Financial Operations.

Authorization to release infor... Authorization To Release Information This release will be used for the purpose of facilitating and expediting the transaction contemplated by the listing agreement between the undersigned and . It

Dog name change authorization... Dog Name Change Authorization Note: items may be mailed separately $ $ $ 2 5 BV1AC Submit this form to request a change to the name of an AKC-registered dog that was whelped in the USA. Please read

Bank of america forms 3rd part... Short Sale Third-Party Authorization Form BORROWER(S) ACKNOWLEDGMENT Loan Number: Borrower: Property Address: Address City State ZIP Co-Borrower: The undersigned Borrower and Co-Borrower (if any)

Healthfirst eft and era author... EFT/ERA Authorization Form Rev. 11/17/06 Type of Transaction (please choose) Add ERA and EFT Change ERA Change EFT Terminate ERA and EFT Physician Group Notes: You need only fill out one EFT/ERA Authorization

Authorization school form CALIFORNIA DEPARTMENT OF JUSTICE Application for Authorization Pursuant to Education Code 33192 33195. 3 and 45125. 1 School Contractors BUREAU OF CRIMINAL INFORMATION AND ANALYSIS Mail Completed application to Department of Justice Applicant Information and Certification Program P. 3 and 45125. 1 School Contractors BUREAU OF CRIMINAL INFORMATION AND ANALYSIS Mail Completed application to Department of Justice Applicant Information and Certification Program P. O. Box 903387 Sacramento CA 94203-3870 TABLE OF CONTENTS Authorization for Criminal History Information.. Services provided under contract must be performed on school grounds 3. The entity must have a contract entities in the bid process are not authorized 4. Completed applications for authorization must have original signatures only no photocopied signatures or faxed forms will be accepted or processed CONSTRUCTION CONTRACTORS 33193 33195. PAGE 18 Utilized ONLY AFTER receiving DOJ authorization confirmation. PAGE 19 CORI Policy Employee Statement. PAGE 20 Contract for Subsequent Arrest Notification Service BCII 8049 No Longer Interested Notification. PAGE 22 In accordance with California Education Code Sections 33192 33195. 3 and 45125. 1 a school district heritage school or private school may require an entity that has an existing contract with a district/heritiage/private school to obtain a criminal history clearance. We sincerely hope that this information will be useful and will answer your questions about the electronic processing of fingerprints in California. DEPARTMENT OF JUSTICE REQUEST FOR AUTHORIZATION TO RECEIVE STATE SUMMARY CRIMINAL HISTORY INFORMATION - CONTRACT EMPLOYEE FOR PUBLIC/HERITAGE PRIVATE SCHOOLS Name of Contractor Mailing Address City State Zip Code Phone Number Facsimile Number entity that has an existing contract with a school district to obtain a criminal history clearance. CALIFORNIA DEPARTMENT OF JUSTICE Application for Authorization Pursuant to Education Code 33192 33195. 3 and 45125. 1 School Contractors BUREAU OF CRIMINAL INFORMATION AND ANALYSIS Mail Completed application to Department of Justice Applicant Information and Certification Program P. O. Box 903387 Sacramento CA 94203-3870 TABLE OF CONTENTS Authorization for Criminal History Information*. PAGE 1 Applicant Live Scan Overview. PAGE 3 Request for Contributing Agency ORI and/or Response Mail Code BCII 9001 REQUIRED. PAGE 6 Guidelines for Completing Request for Contributing Agency ORI and/or Response Mail Code BCII 9001. PAGE 7 Notification of ORI Mail Code and/or Billing Number Assignment REQUIRED. PAGE 8 Billing Account Application BCII 9000 REQUIRED - Only if your agency will be billed for services. PAGE 11 Applicant Fingerprint Response Subscriber Agreement REQUIRED - Please return Page 14 and 15 with this application. PAGE 12 Criminal Offender Record Information CORI Policy REQUIRED - Head of Contributing Agency/Organization. PAGE 16 CORI Policy REQUIRED - Custodian of Records. PAGE 17 Custodian of Records Application Form BCIA 8374 REQUIRED.

Ach credit authorization form Credit/Debit Authorization Form I (we) hereby authorize City of Tybee Island to initiate entries to my (our) checking/savings account at the financial institution listed below, and, if necessary,

Authorization form to release... Annapolis Baltimore Easton Frederick Owings Mills Salisbury Towson Waldorf 929 West St., Annapolis, MD 21401 330 N. Howard Street, Baltimore, MD 21201 8579 Commerce Drive #102, Easton, MD 21601 170

Authorization to return to can... Please complete this form if you are inadmissible to Canada because you were the subject of a removal order or have been told by Canadian immigration you require an ARC to re-enter Canada. Print Form

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