Intake Form - No Cost Partnership

No Cost Partnership

Have these services started?

Requested Board Date

This date must be at least 10 weeks from today date. You can access the board dates here

mm/dd/yyyy

Start Date of Services

Agreement Term is the date the services shall commence.

mm/dd/yyyy

End Date of Services

Agreement Term is the date the services shall end on.

mm/dd/yyyy

Requestor Name

Point of Contact if there are questions related to this intake form. It is important this information is complete and accurate.

Requestor Title

Requestor Email

Work email address (sandi.net)

Requestor Phone

Phone

Department ID

Please use 4 digits.

District Contract Representative (DCR) Name

This is the District employee that will supervise the services being performed.

DCR Title

DCR Department Name

DCR Address

Please include Address, City, State, and Zip.

CR Email

DCR Phone

Phone

Agreement with (Company Name) Legal Name

This is the legal name of the company or person performing services and matched the W9 form.

Company Point of Contact Name

Person signing the contract

Company's Point of Contact Title

Company Address

Please include Address, City, State, and Zip.

Company Email

Of the person signing the contract on behalf of the company

Company Phone

Phone

Items Needed. Attach all applicable Items to expedite the contracting process

1. Scope of Work or Proposal

Drop your files here

RECOMMENDATION FOR BOARD AGENDA: This Agreement will provide the District with what type of services

(e.g.: WHAT from WHOM and for HOW LONG):

Important Notes to Contract Specialist:

Authorized Approver

Choose your Area Superintendent, Director, or Chief.

Authorized Approver's Title, Email, and Phone No.

This information is needed for the Board Agenda.

Send me a copy of my responses

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