Program Guidelines: 1. The program must be primarily for the general public low income family whose intent is to maintain their pet in their home.
|
|
- Héctor Fernández Segura
- hace 8 años
- Vistas:
Transcripción
1
2
3 ATTACHMENT A Program Guidelines: The primary purpose of this program is to prevent animal surrenders due to a family s inability to feed their pet(s). The following procedures are requested of all DaisyCares Pet Food Program participants: 1. The program must be primarily for the general public low income family whose intent is to maintain their pet in their home. 2. Animal Shelters / Rescue organizations may utilize no more than 20 % of all product acquired through the DaisyCares Pet Food Program for internal pet maintenance. 3. Program participants are required to accept referrals from the SAFB and United Way s 211 help line of families in need of pet food assistance. 4. Program participants will be asked to submit monthly reports on pet product distribution to families. (This report will be available online for online submission as well as a hard copy will be provided to all program participants.) 5. Product acquired under the DaisyCares Pet Food Program will be free to program participants (up to quantities dictated by the SAFB). 6. DaisyCares Pet Food Product may NOT be redistributed to any other organization and must be distributed solely by the program participant (interested organizations should contact the SAFB for information on how to participate in the program). 7. DaisyCares Pet Food Product may only be distributed to families who fall under the low income guidelines or families receiving federal benefits such as TANF, WIC, CHIP, MEDICAID, SNAP (Food Stamps), or individuals who are disabled and low income. 8. The SAFB family intake form must be used to qualify families (this form is available on our website) and these intake files should be retained for a minimum of 3 years.
4 ATTACHMENT B Agency Name: Agency Account Number: Program Contact Person Name: Program Contact Person Program Contact Person Phone Number: Families you estimate you can assist with this program? Are you an animal / wildlife affiliated organization? Do you understand that you will have to assist families referred to you by the San Antonio Food Bank as well as the United Way 211 Referral Center? By signing this document you are committing to distribute pet food on behalf of the Daisy Cares Pet Food Program and follow and rules and guidelines of this program, including open service to the community as well as reporting guidelines: Signature Date Printed Name: Please fax this agreement to (210) or agreement to mdemers@safoodbank.org
5 ATTACHMENT D Monthly Report The primary purpose of this program is to prevent animal surrenders due to a family s inability to feed their pet(s). The following report is due to Compliance & Capability by the 5 th of the month following the distribution month. Agency Name: Please submit this report online at or by to mdemers@safoodbank.org or by fax (210) Agency Account Number: Number of Families served with DaisyCares Pet Food Program: Number of Pets served with DaisyCares Pet Food Program:
6 ATTACHMENT C Sign In Sheet Agency Name: Agency Account Number: Month: Date Name # Cats # Dogs # other
7 Page 1 of 2 San Antonio Food Bank Partner Agency Pantry Family Intake Form Form B Please answer all questions so that we may serve you better. This information will not be shared with any other outside agency or entity others than the San Antonio Food Bank for reporting purposes. CLIENT DOCUMENTATION (client may fill this out) Date of Intake: Are you homeless? Yes No If no, please complete address portion of form. Household Information YOUR NAME ADDRESS CITY / STATE/ ZIP/ COUNTY PHONE How many people live in your house: Are you? African American Are you head of the household? Asian Caucasian Hispanic Native American Other How many people live in your house in the following age / gender groups: (please write the number in the box) 0-5 yrs 6-18 yrs yrs yrs 60 and over # Males in house # Females in house How many people live in your house in the following age / gender groups: (please write the number in the box) Physically Abuse Mentally People with Chronic Illness Elderly Disabled Victims Disabled Homeless Other: (specify) Military (active, retired or reserve) Does your family receive any type of assistance? check all that apply Temporary Assistance To Needy Families (TANF / AFDC) SSI CHIP SNAP (Food Stamps) Medicaid WIC The Total Gross Income (the amount before deductions) of all household members is: GROSS Per Year Per Month Per Week INCOME $ Was there an emergency situation that caused you to need food? Yes No If yes, please state situation Yes No Client Signature (client must be present for initial interview and food assistance) I certify that I am a member of the household listed above and that on behalf of this household I have applied for USDA Products. I certify that all information regarding my household is true to the best of my knowledge. I also designate the following person as an authorized representative of my household and certify that their information is correct to the best of my knowledge. Authorized representative is able to pick up product for client until re-certification is necessary Date Name of Authorized Representative:(not name of family member only person to act on their behalf) Authorized Representatives Address The Texas Department of Agriculture, the San Antonio Food Bank, and the agency providing you food, will not discriminate against you, directly or through contractual or other arrangements. The law* says you cannot be discriminated against because of your race, color, national origin, age, political belief, disability or sex. Member Agency Guidebook Form B
8 Page 2 of 2 AGENCY DOCUMENTATION Family Name: Date: Household is INELIGIBLE: (clients denied USDA products should be referred to the SAFB for review) Income level over 185% listed on Annual Income Guidelines Is not an emergency situation and does not meet any other criteria Other: Household is ELIGIBLE based on: Low Income (Enter certification period below; sign and date the form at the bottom) Emergency Food Need (Describe emergency need in Comments section; enter Certification Period; sign and date the form, clients in this category may be served no more than 6 months unless another emergency can be documented.) Receipt of TANF/AFDC (Enter the Certification Period; sign and date the form.) Receipt of Food Stamps (Enter Certification Period; sign and date the form.) Receipt of SSI (Enter the Certification Period; sign and dater the form.) Receipt of Medicaid (Enter the Certification Period; sign and date the form. Certification Period: Start Date: End Date: Comments: Agency Staff Initials: Revisit this form on: Please have client sign every time they come receive assistance (if you have another form for this that is fine, but you must keep all documentation accessible and together) Date Signature of Client (by client) The Texas Department of Agriculture, the San Antonio Food Bank, and the agency providing you food, will not discriminate against you, directly or through contractual or other arrangements. The law* says you cannot be discriminated against because of your race, color, national origin, age, political belief, disability or sex. Member Agency Guidebook Form B
9 Página 1 de 2 San Antonio Food Bank Formulario de Inscripción para Individuos / Familias Form C Favor de responder a todas las preguntas de manera que podamos servirle mejor. Esta información no será compartida con ninguna otra agencia u entidad otra que el Banco de Comida de San Antonio para razones de reportaje. DOCUMENTACION DEL CLIENTE (el cliente puede llenar este) Fecha de Inscripción: Esta usted sin hogar: Si No Si la respuesta es no, llenar la información de domicilio Su Nombre Su Domicilio Ciudad/Estado/Zip/Condado Teléfono Cuantas personas viven en su hogar: Es usted: Africano- Americano Asiático Anglo- Sajón Es usted cabeza de familia: Hispano Indígena Otro Cuantas personas en su hogar son de las siguientes edades/géneros (favor de poner el número en cada caja) 0-5 años: 6-18 años: años: años: 60 y mayor: # de Hombres en el Hogar # de Mujeres en el Hogar Cuantas personas en su hogar son de las siguientes categorias (favor de poner el número en cada caja) Personas Mayores Sin Hogar Personas Con Discapacidad física Victimas de abuso Personas con discapacidad mental Militares (veteranos, jubilados, activos, reservista) Personas con enfermedades cronicas Otros: (especifique) Su familia recibe alguna forma de asistencia? Si No Si la respuesta es si, indique cuales con una X. Asistencia Temporaria Para Familias Necesitadas (TANF/AFDC) Estampillas de comida SSI Medicaid CHIP WIC Los ingresos totales (antes de deducciones) para todos los miembros del hogar son: Los ingresos totales $ Por año Por Mes Por Semana Hubo alguna situación de emergencia que causo la falta de comida Si No Si la respuesta es si, describa esta situación: Si No Firma de cliente (es necesario que cada cliente este presente la primera vez que reciben asistencia) Fecha Certifico que soy miembro del hogar descrito arriba y como representante de este hogar he aplicado para productos del USDA. Certifico que toda la información tocante a mi hogar es verdadera según mi conocimiento. Designo además la siguiente persona como representante de mi hogar y certifico que su información es correcta según mi conocimiento. El individuo con el firma abajo es responsable de recibir asistencia en nombre del cliente cada distribución hasta la fecha de re-certificación. Nombre de Representante Autorizado Domicilio de Representante Autorizado El Departamento de Agricultura de Texas, San Antonio del Banco de Alimentos, y la agencia que le proporciona alimentos, no se discrimina en contra de usted, directamente oa través de acuerdos contractuales o de otro tipo. * La ley dice que no puede ser discriminado por su raza, color, origen nacional, edad, ideología política, discapacidad o sexo. Member Agency Guidebook Form C
10 Página 2 de 2 AGENCY DOCUMENTATION (not in Spanish because agency fills out ) Family Name: Date: Household is INELIGIBLE: (clients denied USDA products should be referred to the SAFB for review) Income level over 185% listed on Income Guidelines Is not an emergency situation and does not meet any other criteria Other: Household is ELIGIBLE based on: Low Income (Enter certification period below; sign and date the form at the bottom) Emergency Food Need (Describe emergency need in Comments section; enter Certification Period; sign and date the form. Clients in this category may receive assistance up to 6 months unless another emergency can be documented. ) Receipt of TANF/AFDC (Enter the Certification Period; sign and date the form.) Receipt of Food Stamps (Enter Certification Period; sign and date the form.) Receipt of SSI (Enter the Certification Period; sign and dater the form.) Receipt of Medicaid (Enter the Certification Period; sign and date the form. Certification Period: Start Date: End Date: Comments: Agency Staff Initials: Revisit this form on: Please have client sign every time they come receive assistance (if you have another form for this that is fine, but you must keep all documentation accessible and together) Date Signature of Client (by client) El Departamento de Agricultura de Texas, San Antonio del Banco de Alimentos, y la agencia que le proporciona alimentos, no se discrimina en contra de usted, directamente oa través de acuerdos contractuales o de otro tipo. * La ley dice que no puede ser discriminado por su raza, color, origen nacional, edad, ideología política, discapacidad o sexo. Member Agency Guidebook Form C
Program Guidelines. 1. The program must be primarily for the general public low income family whose intent is to maintain their pet in their home.
Program Guidelines The primary purpose of this program is to prevent animal surrenders due to a family s inability to feed their pet(s). The following procedures are requested of all DaisyCares Pet Food
Más detallesTITLE VI COMPLAINT FORM
[CITY SEAL/EMBLEM] The Capital City of the Palm Beaches TITLE VI COMPLAINT FORM Title VI of the 1964 Civil Rights Act requires that "No person in the United States shall, on the ground of race, color or
Más detallesTITLE VI COMPLAINT FORM
TITLE VI COMPLAINT FORM Before filling out this form, please read the Arcata and Mad River Transit System Title VI Complaint Procedures located on our website or by visiting our office. The following information
Más detallesEl Abecedario Financiero
El Abecedario Financiero Unidad 4 National PASS Center 2013 Lección 5 Préstamos Vocabulario: préstamo riesgocrediticio interés obligadosolidario A lgunavezpidesdineroprestado? Dóndepuedespedirdinero prestado?
Más detalles2015 16 Student Eligibility Verification Advanced Placement/International Baccalaureate Test Fee Program
2015 16 Student Eligibility Verification Advanced Placement (AP) and/or International Baccalaureate (IB) Exams AP Exam IB Exam AP and IB Exams I. Student Information Last Name First Name MI Grade High
Más detallesLump Sum Final Check Contribution to Deferred Compensation
Memo To: ERF Members The Employees Retirement Fund has been asked by Deferred Compensation to provide everyone that has signed up to retire with the attached information. Please read the information from
Más detallesWelcome to the CU at School Savings Program!
Welcome to the CU at School Savings Program! Thank you for your interest in Yolo Federal Credit Union s CU at School savings program. This packet of information has everything you need to sign your child
Más detalles2014 15 Student Eligibility Verification Advanced Placement/International Baccalaureate Test Fee Program
2014 15 Student Eligibility Verification Advanced Placement (AP) and/or International Baccalaureate (IB) Exams þ AP Exam IB Exam AP and IB Exams I. Student Information Last Name First Name MI Grade High
Más detallesMANUAL EASYCHAIR. A) Ingresar su nombre de usuario y password, si ya tiene una cuenta registrada Ó
MANUAL EASYCHAIR La URL para enviar su propuesta a la convocatoria es: https://easychair.org/conferences/?conf=genconciencia2015 Donde aparece la siguiente pantalla: Se encuentran dos opciones: A) Ingresar
Más detallesDown Payment Assistance Application Packet
Down Payment Assistance Application Packet Please assure that all needed items are attached and complete. Please note that your application will not be considered until all documents are received. 1. Down
Más detalleswww.deltadentalins.com/language_survey.html
Survey Code: Survey 1 February 6, 2008 Dear Delta Dental Enrollee: Recent changes in California law will require that all health care plans provide language assistance to their plan enrollees beginning
Más detallesDaly Elementary. Family Back to School Questionnaire
Daly Elementary Family Back to School Questionnaire Dear Parent(s)/Guardian(s), As I stated in the welcome letter you received before the beginning of the school year, I would be sending a questionnaire
Más detallesOJO: Todos los formularios deberán llenarse en inglés. De lo contrario, no se le permitirá presentar sus documentos ante la Secretaría del Tribunal.
OJO: Todos los formularios deberán llenarse en inglés. De lo contrario, no se le permitirá presentar sus documentos ante la Secretaría del Tribunal. For Clerk s Use Only (Para uso de la Secretaria solamente)
Más detallesGuide to Health Insurance Part II: How to access your benefits and services.
Guide to Health Insurance Part II: How to access your benefits and services. 1. I applied for health insurance, now what? Medi-Cal Applicants If you applied for Medi-Cal it will take up to 45 days to find
Más detallesChattanooga Motors - Solicitud de Credito
Chattanooga Motors - Solicitud de Credito Completa o llena la solicitud y regresala en persona o por fax. sotros mantenemos tus datos en confidencialidad. Completar una aplicacion para el comprador y otra
Más detallesStudent Violence, Bullying, Intimidation, Harassment
Case 4:74-cv-00090-DCB Document 1690-6 Filed 10/01/14 Page 159 of 229 Student Violence, Bullying, Intimidation, Harassment COMPLAINT FORM (To be filed with any School District employee who will forward
Más detallesPB #11-111-OPE. Attachment: Please use Print on M-687r Referral to Treatment Program (Rev. 11/30/11) (Rev. 11/30/11)
FAMILY INDEPENDENCE ADMINISTRATION Matthew Brune, Executive Deputy Commissioner James K. Whelan, Deputy Commissioner Policy, Procedures, and Training Stephen Fisher, Assistant Deputy Commissioner Office
Más detallesODJFS Bureau of Civil Rights. ODJFS Bureau of Civil Rights. ODJFS Bureau of Civil Rights. ODJFS Bureau of Civil Rights
ODJFS Bureau of Civil Rights I NEED AN INTERPRETER, PLEASE. Title VI of the Civil Rights Act of 1964 prohibits discrimination on the basis of national origin. If you do not speak English well, social services,
Más detallesPRINTING INSTRUCTIONS
PRINTING INSTRUCTIONS 1. Print the Petition form on 8½ X 11inch paper. 2. The second page (instructions for circulator) must be copied on the reverse side of the petition Instructions to print the PDF
Más detallesWorkers Compensation Non-Subscriber Form
Workers Compensation Non-Subscriber Form Texas is unique in one very important respect: It s the only state in which employers have the choice to carry workers compensation insurance or not. There are
Más detallesCreating your Single Sign-On Account for the PowerSchool Parent Portal
Creating your Single Sign-On Account for the PowerSchool Parent Portal Welcome to the Parent Single Sign-On. What does that mean? Parent Single Sign-On offers a number of benefits, including access to
Más detallesPurpose of Sliding Scale Policy and Procedure Disclaimer Policy
San Luis Valley Health s Behavioral Health department offers a sliding fee discount program to eligible patients. If you would like more information, please call 589-8008, or ask one of our Admitting Clerks
Más detallesAffordable Care Act Informative Sessions and Open Enrollment Event
2600 Cedar Ave., P.O. Box 2337, Laredo, TX 78044 Hector F. Gonzalez, M.D., M.P.H Tel. (956) 795-4901 Fax. (956) 726-2632 Director of Health News Release. Date: February 9, 2015 FOR IMMEDIATE RELEASE To:
Más detallesFinancial Affidavit for Child Support, DC 6:5(2) Declaración Jurada de Finanzas para Manutención de Menores, DC 6:5(2).
IN THE DISTRICT CURT F CUNTY, NEBRASKA (county where Complaint filed) EN LA CRTE DE DISTRIT DEL CNDAD DE, NEBRASKA (condado donde se entabló la Demanda), ) (your full name) (su nombre completo) ) Plaintiff,/
Más detallesScreener for Peer Supporters
Screener for Peer Supporters Primary Recruiter: Secondary Recruiter: Potential Peer Supporter Name: Phone #1: Home/Cell Phone #2: Home/Cell Address: City: Zip: Contact 1: Date: / / Contact 2: Date: / /
Más detallesCivil Rights Complaint Form
Civil Rights Complaint Form It is the policy of the Greater Derry Salem Cooperative Alliance for Regional Transportation (CART) to uphold and assure full compliance with Title VI of the Civil Rights Act
Más detallesIdentity and Statement of Educational Purpose (To Be Signed in the Presence of a Notary)
Identity and Statement of Educational Purpose (To Be Signed in the Presence of a Notary) If the student is unable to appear in person at (Name of Postsecondary Educational Institution) to verify his or
Más detallesPuede pagar facturas y gastos periódicos como el alquiler, el gas, la electricidad, el agua y el teléfono y también otros gastos del hogar.
SPANISH Centrepay Qué es Centrepay? Centrepay es la manera sencilla de pagar sus facturas y gastos. Centrepay es un servicio de pago de facturas voluntario y gratuito para clientes de Centrelink. Utilice
Más detallesEl límite mínimo para las cuentas comerciales grandes es de $2,000/mes por el uso del servicio.
ONNETIUT OBERTURA DEL FORMULARIO DE FAX PARA: XOOM Energy lientes omerciales No. FAX: 866.452.0053 FEHA: NOMBRE DE EMPRESARIO INDEPENDIENTE: # IDENTIFIAIÓN DE NEGOIO: ORREO ELETRÓNIO: # DE PÁGINAS: TELÉFONO:
Más detallesTEXAS DEPARTMENT OF STATE HEALTH SERVICES
TEXAS DEPARTMENT OF STATE HEALTH SERVICES DAVID L. LAKEY, M.D. COMMISSIONER P.O. Box 149347 Austin, Texas 78714-9347 1-888-963-7111 TTY: 1-800-735-2989 www.dshs.state.tx.us August 15, 2013 Dear Birthing
Más detallesRENT CONTROL BOARD OF THE TOWN OF WEST NEW YORK, N.J. 428-60 TH STREET WEST NEW YORK, N.J. 07093-2231 (201) 295-5290/91/92
FELIX E. ROQUE, MD MAYOR DEPT. OF PUBLIC AFFAIRS RENT CONTROL BOARD RENTAL AGREEMENT APPLICATION NAME OF ADDRESS OF LANDLORD: PROPERTY ADDRESS: APARTMENT #: 3 COPIES (1) Original rental agreement signed
Más detallesRegistro de Semilla y Material de Plantación
Registro de Semilla y Material de Plantación Este registro es para documentar la semilla y material de plantación que usa, y su estatus. Mantenga las facturas y otra documentación pertinente con sus registros.
Más detallesChild Care Assistance Program Búsqueda de Trabajo
Child Care Assistance Program Búsqueda de Trabajo Usted ha pedido cuidado para sus niños mientras busca trabajo a través del programa de CCAP. Este programa ofrece un total de 30 días mientras busca trabajo.
Más detallesLow-Income Telephone and Electric Discount Programs Enrollment Form (LITE-UP) For Questions, Call LITE-UP Texas toll-free at 1-866-454-8387
Low-Income Telephone and Electric Discount Programs Enrollment Form (LITE-UP) For Questions, Call LITE-UP Texas toll-free at 1-866-454-8387 January 27, 2009 Courtesy_Title Full_Name 1 Mail_Address_2 Mail_Address_1
Más detallesTitle VI Complaint Procedures
Title VI Complaint Procedures As a recipient of federal dollars, HELP of Ojai, Inc. is required to comply with Title VI of the Civil Rights Act of 1964 and ensure that services and benefits are provided
Más detallesVoter Information Guide and Sample Ballot
Voter Information Guide and Sample Ballot Special Election San Bernardino Mountains Community Hospital District Tuesday, June 4, 2013 Elections Office of the Registrar of Voters 777 East Rialto Ave. San
Más detallesTitle VI Complaint Form Horizon Cross Cultural Center (HORIZON) (formerly St. Anselm s Cross-Cultural Community Center) Office of Civil Rights
Title VI Complaint Form Horizon Cross Cultural Center (HORIZON) (formerly St. Anselm s Cross-Cultural Community Center) Title VI of the Civil Rights Act of 1964 provides that no person in the United States
Más detallesSOLICITUD DE FAMILIA
SOLICITUD DE FAMILIA DETALLES DE LA FAMILIA ABOUT YOUR FAMILY Apellidos (Padre) Father's family name(s) Nombres Christian names Apellidos (Madre) Mother's family name(s) Nombres Christian names Dirección
Más detallesHABERSHAM COUNTY SCHOOLS LAS ESCUELAS DEL CONDADO DE HABERSHAM ENROLLMENT/STUDENT INFORMATION FORM FORMA DE MATRICULACION
HABERSHAM COUNTY SCHOOLS LAS ESCUELAS DEL CONDADO DE HABERSHAM ENROLLMENT/STUDENT INFORMATION FORM FORMA DE MATRICULACION CHILD LIVES IN SCHOOL DISTRICT (PLEASE GIVE NAME OF ELEMENTARY SCHOOL) (distrito
Más detallesSteps to Understand Your Child s Behavior. Customizing the Flyer
Steps to Understand Your Child s Behavior Customizing the Flyer Hello! Here is the PDF Form Template for use in advertising Steps to Understanding Your Child s Behavior (HDS Behavior Level 1B). Because
Más detallesSAN BERNARDINO & RIVERSIDE COUNTIES. Catholic Charities. Moreno Valley Regional Center. 23623 Sunnymead Blvd., Ste. E Moreno Valley, CA 92553
SAN BERNARDINO & COUNTIES Catholic Charities Moreno Valley Regional Center 23623 Sunnymead Blvd., Ste. E Family and Community Assistance Programs Information & Referral, Case Management Basic Needs, Emergency
Más detallesSi tiene cualquier pregunta llame a su trabajadora de CCAP al número de teléfono indicado abajo. Boulder County Child Care Assistance Program
Child Care Assistance Program Búsqueda de Trabajo Usted ha pedido cuidado para sus niños mientras busca trabajo a través del programa de CCAP. Este programa ofrece un total de 30 días mientras busca trabajo.
Más detalles\RESOURCE\ELECTION.S\PROXY.CSP
The following is an explanation of the procedures for calling a special meeting of the shareholders. Enclosed are copies of documents, which you can use for your meeting. If you have any questions about
Más detallesHistoric Architectural
Historic Architectural Rehabilitation Grant Program 50/50 GRANT PROGRAM 75/25 GRANT PROGRAM EXTERIOR PAINT PROGRAM CITY OF Elgin PLANNING & NEIGHBORHOOD SERVICES CITY OF Elgin Historic Architectural Rehabilitation
Más detallesAre you interested in helping to GOVERN the Authority, DEVELOP current and future programs, and APPROVE contracts?
Albany Housing Authority RESIDENT COMMISSIONER ELECTION Are you interested in helping to GOVERN the Authority, DEVELOP current and future programs, and APPROVE contracts? RUN FOR RESIDENT COMMISSIONER
Más detallesPROCEDIMIENTOS: QUÉ HACER CON EL PEDIMENTO UNA VEZ QUE SE HA COMPLETADO
CENTRO DE AUTOSERVICIO PROCEDIMIENTOS: QUÉ HACER CON EL PEDIMENTO UNA VEZ QUE SE HA COMPLETADO PASO 1: COPIAS Y SOBRES. Haga tres (3) copias de las páginas siguientes del pedimento; Haga dos (2) copias
Más detallesIRS DATA RETRIEVAL NOTIFICATION DEPENDENT STUDENT ESTIMATOR
IRS DATA RETRIEVAL NOTIFICATION DEPENDENT STUDENT ESTIMATOR Subject: Important Updates Needed for Your FAFSA Dear [Applicant], When you completed your 2012-2013 Free Application for Federal Student Aid
Más detallesCivil Rights Complaint Form
Civil Rights Complaint Form Title VI of the 1964 Civil Rights Act and related non-discrimination statutes and regulations require that no person in the United States shall, on the ground of race, color,
Más detallesAsistencia para alimentos de Iowa (Iowa Food Assistance Program) SCRIPT
Asistencia para alimentos de Iowa (Iowa Food Assistance Program) http://video.extension.iastate.edu/2011/12/14/asistencia para alimentos de iowa/ Six minute video in Spanish explaining what Food Assistance
Más detallesPeru Tourist visa Application for citizens of Costa Rica living in Ontario - Ottawa, Gatineau
Peru Tourist visa Application for citizens of Costa Rica living in Ontario - Ottawa, Gatineau Please enter your contact information Name: Email: Tel: Mobile: The latest date you need your passport returned
Más detallesIdentity and Statement of Educational Purpose Instruction Sheet
Identity and Statement of Educational Purpose Instruction Sheet You must appear in person at Midwestern State University Financial Aid Office (MSU-FAO) to present your governmentissued ID (such as driver
Más detallesNews Flash! Primary & Specialty Care Providers. Sharp Health Plan. Date: February 17, 2012. Subject: Member Grievance Forms
I M P O R T A N T News Flash! A FAX Publication for Providers of Sharp Health Plan To: From: Primary & Specialty Care Providers Sharp Health Plan Date: February 17, 2012 Subject: Member Grievance Forms
Más detallesSolicitud para Certificado de soltería (Certificate of Non-Impediment Request)
Solicitud para Certificado de soltería (Certificate of Non-Impediment Request) Este documento contiene una traducción de la solicitud en línea para obtener un Certificado de soltería (o Certificate of
Más detallesGrandparents Raising Grandchildren. Assistance is available for grandparents caring for grandchildren living in their home.
Grandparents Raising Grandchildren Assistance is available for grandparents caring for grandchildren living in their home. Grandparents Raising Grandchildren The Texas Health and Human Services Commission
Más detallesThe Home Language Survey (HLS) and Identification of Students
The Home Language Survey (HLS) and Identification of Students The Home Language Survey (HLS) is the document used to determine a student that speaks a language other than English. Identification of a language
Más detallesCHANGE OF FAMILY COMPOSITION PACKET - REMOVE MEMBER
818 S. FLORES ST. SAN ANTONIO, TEXAS 78204 www.saha.org CHANGE OF FAMILY COMPOSITION PACKET - REMOVE MEMBER Participant: In an effort to ensure you/your family is served in a timely manner, we are requesting
Más detallesWelcome Savers! 1. Fill out application form if you re not already a Yolo FCU member.
Welcome Savers! Yolo Federal Credit Union and Montgomery Elementary School have teamed up again this year to bring you our school saving program! It s easy to participate... 1. Fill out application form
Más detallesOrden de domiciliación o mandato para adeudos directos SEPA. Esquemas Básico y B2B
Orden de domiciliación o mandato para adeudos directos SEPA. Esquemas Básico y B2B serie normas y procedimientos bancarios Nº 50 Abril 2013 INDICE I. Introducción... 1 II. Orden de domiciliación o mandato
Más detallesAdult Application 18 and over ONLY ******************************** Aplicación de Adultos Solo para mayores de 18 años
Adult Application 18 and over ONLY ******************************** Aplicación de Adultos Solo para mayores de 18 años FREE GRATIS Beacon Programs Adult Enrollment Form Beacon PROGRAMS Participant Information
Más detallesWISE AREA RELIEF MISSION APPLICATION FOR ASSISTANCE (Aplicación para ayuda)
o o NEW UPDATE WISE AREA RELIEF MISSION APPLICATION FOR ASSISTANCE (Aplicación para ayuda) o o BOX NO BOX Date (Fecha) The information supplied below is used by W.A.R.M. in providing assistance. Should
Más detallesBarbara Quaid. March 1, Dear Ventura County Teachers:
March 1, 2018 Dear Ventura County Teachers: The Ventura County Fair invites students to earn free carnival rides through our reading program, Read & Ride for local kindergarten through 8 th grade students.
Más detallesThis grant only covers deliveries to the building, up to the grant award.
Citizens Energy /CITGO Petroleum Oil Heat Program 2015 EXPLANATION OF GRANT TERMS & CONDITIONS FOR BOARD MEMBERS If Awarded A Grant, HDFC s Agree To The Following Grant Regulations: This grant only covers
Más detallesPODER NOTARIAL DE UN MENOR DE EDAD
POWER OF ATTORNEY OVER A MINOR PODER NOTARIAL DE UN MENOR DE EDAD PUEDE USAR ESTE PAQUETE SÓLO SI SE CUMPLEN TODAS LAS SIGUIENTES CONDICIONES:! Usted desea dar autoridad temporal sobre su hijo a otra persona.!
Más detallesEmployer Employer Address Phone. Phone: Home Work Cell
PATIENT REGISTRATION Last Name First Name MI Date of Birth Age Social Security # Gender Marital Status Address Street Apt# City State Zip Phone: Home Work Cell E-Mail Occupation Retired: Yes No Employer
Más detallesInstructor: She just said that she s Puerto Rican. Escucha y repite la palabra Puerto Rican -for a man-.
Learning Spanish Like Crazy Spoken Spanish Lección once Instructor: Cómo se dice Good afternoon? René: Buenas tardes. Buenas tardes. Instructor: How do you ask a woman if she s Colombian. René: Eres Colombiana?
Más detallesHEAD START MEDICATION ADMINISTRATION
HEAD START MEDICATION ADMINISTRATION Dear Parents/Guardians: It is the policy of Head Start to cooperate with each Head Start child's parent/guardian and his/her physician by administering and providing
Más detallesBecoming Independent Title VI Program
Title VI Complaint Procedures As a recipient of federal fund, Becoming Independent is required to comply with Title VI of the Civil Rights Act of 1964 and ensure that program and services are provided
Más detallesCNS Paragraph Form Date: 09.02.11
CNS Paragraph Form Date: 09.02.11 Program Area 03 (01=PA, 02=FS, 03=MA, 04=HP) Paragraph Number U0223 Version Number 00001 Effective Date 2011 Title Administrative Renewal for Aged, Blind and Disabled,
Más detallesAGENCY POLICY: REVIEW OF NOTICE OF PRIVACY PRACTICES
AGENCY POLICY: REVIEW OF NOTICE OF PRIVACY PRACTICES SCOPE OF POLICY This policy applies to all agency staff members. Agency staff members include all employees, trainees, volunteers, consultants, students,
Más detallesANNUAL REPORT OF GUARDIAN ON CONDITION OF WARD/INCAPACITATED PERSON INFORME ANUAL DEL TUTOR SOBRE LA CONDICIÓN DEL PUPILO/PERSONA INCAPACITADA/INHÁBIL
Nebraska State Court Form REQUIRED Formulario del Tribunal del Estado de Nebraska REQUERIDO ANNUAL REPORT OF GUARDIAN ON CONDITION OF WARD/INCAPACITATED PERSON INFORME ANUAL DEL TUTOR SOBRE LA CONDICIÓN
Más detallesDEPARTAMENTO ESTATAL DE SERVICIOS DE SALUD DE TEXAS
DEPARTAMENTO ESTATAL DE SERVICIOS DE SALUD DE TEXAS DAVID L. LAKEY, M.D. DIRECTOR P.O. Box 149347 Austin, Texas 78714-9347 1-888-963-7111 TTY (teletipo): 1-800-735-2989 www.dshs.state.tx.us 1 de marzo,
Más detallesGoodwill Serving the People of Southern Los Angeles County. Title VI Notice to the Public
Title VI Notice to the Public Notifying the Public of Rights Under Title VI (Goodwill SOLAC) operates its programs and services without regard to race, color, and national origin in accordance with Title
Más detallesFor more information regarding these forms please go to the Texas Department of Insurance website http://www.tdi.state.tx.us/forms/form20employer.
CAPROCK Claims Management, LLC ROCK SOLID PERFORMANCE AND RESULTS PO Box 743427 Dallas, TX 75374 (888) 812-3577 Fax (972) 934-3091 IMPORTANT NOTICE FOR REQUIRED FILING FORMS DWC FORM-5 & DWC FORM-7 Caprock
Más detallesWelcome to lesson 2 of the The Spanish Cat Home learning Spanish course.
Welcome to lesson 2 of the The Spanish Cat Home learning Spanish course. Bienvenidos a la lección dos. The first part of this lesson consists in this audio lesson, and then we have some grammar for you
Más detallesEmployment Application FOR PART-TIME OR NON ACADEMIC STUDENT POSITIONS UP TO 25 HOURS PER WEEK OR LESS THAN 4 ½ MONTHS IN LENGTH
NAME: (mbre) DATE (Fecha) EMPLOYMENT DESIRED You may select more than one position (Puesto deseado Puede seleccionar mas de uno) FOOD SERVICE (SERVICIO DE ALIMENTOS) Student Assistant (Asistente Estudiantil)
Más detallesMatemáticas Muestra Cuadernillo de Examen
Matemáticas Muestra Cuadernillo de Examen Papel-Lápiz Formato Estudiante Español Versión, Grados 3-5 Mathematics Sample Test Booklet Paper-Pencil Format Student Spanish Version, Grades 3 5 Este cuadernillo
Más detallesStudent and Adult Release Forms
Student and Adult Release Forms The following sample release forms are provided along with an explanation of the forms and your responsibility. For Tasks 3 and 4, your response will be based, in part,
Más detallesSchool Preference through the Infinite Campus Parent Portal
School Preference through the Infinite Campus Parent Portal Welcome New and Returning Families! Enrollment for new families or families returning to RUSD after being gone longer than one year is easy.
Más detallesSolicitud de Licencia de matrimonio (Marriage License Request)
Solicitud de Licencia de matrimonio (Marriage License Request) Este documento contiene una traducción de la Solicitud en línea para obtener una Licencia o permiso de matrimonio. Si necesita ayuda técnica,
Más detallesA los niños que tienen Medicaid (Asistencia Médica) Jamás debe. cobrárseles unacantidad por las recetas médicas aún cuando tengan
Disability Rights Network of Pennsylvania 1414 N. Cameron Street Second Floor Harrisburg, PA 17103-1049 (800) 692-7443 (Voice) (877) 375-7139 (TDD) www.drnpa.org A los niños que tienen Medicaid (Asistencia
Más detallesCHANGE OF HOUSEHOLD COMPOSITION PACKET INSTRUCTIONS TO REMOVE A MEMBER
CHANGE OF HOUSEHOLD COMPOSITION PACKET INSTRUCTIONS TO Participant: REMOVE A MEMBER In an effort to ensure you and your household are served in a timely manner, we are requesting that you completely fill
Más detallesVerification Worksheet V4 D I
Last Name: First Name: ID: (print clearly) 2018 2019 Verification Worksheet V4 D I Before your financial aid for the 2018/2019 award year can be finalized, federal regulations require that certain data
Más detallesAVISO IMPORTANTE REFERENTE A SU CASO DE ASISTENCIA GENERAL
BERGEN COUNTY BOARD OF SOCIAL SERVICES 216 STATE ROUTE 17 NORTH ROCHELLE PARK, NJ 07662-3300 Tel. (201) 368-4200 FAX: (201) 368-8721 Internet: www.bcbss.com 8 AVISO IMPORTANTE REFERENTE A SU CASO DE ASISTENCIA
Más detallesTownship of Union Complaint Form. Note: The following information is needed to assist in processing your complaint.
Township of Union Complaint Form Note: The following information is needed to assist in processing your complaint. A. Complainant s information: Name: Address: City/State/Zip Code: Telephone Number (Home):
Más detallesThe ADE Direct Certification User Guide is a tool for authorized ADE and school district personnel to use in conjunction with the ADE Direct
The ADE Direct Certification User Guide is a tool for authorized ADE and school district personnel to use in conjunction with the ADE Direct Certification website. 1 This User Guide is a reference guide
Más detallesFondos son LIMITADOS!
El Programa de Asistencia para el Agua durante la Sequía ayuda a hogares de bajos ingresos impactados por la sequía. El Programa provee asistencia con facturas de agua residenciales actuales, retrasadas,
Más detallesPerson ID: <MPI_ID> <Primary Applicant/AREP FMLNS> <Address Line 1> <Address Line 2> <City>, <State> <Zip> Mailed: <Current Date>
Person ID: , Mailed: Your HUSKY Health Coverage is Scheduled to End on August 31st Dear
Más detallesFAMILY INDEPENDENCE ADMINISTRATION Seth W. Diamond, Executive Deputy Commissioner
FAMILY INDEPENDENCE ADMINISTRATION Seth W. Diamond, Executive Deputy Commissioner James K. Whelan, Deputy Commissioner Policy, Procedures, and Training Lisa C. Fitzpatrick, Assistant Deputy Commissioner
Más detallesFamily Criteria Questionnaire
Office Use Only: Program Code: HS STPK ECBG ECSE FL KS Entry Date: US Entry Date: B/C (I 94) on file? Y/N State/Country Family Criteria Questionnaire Child must be 3 or 4 years of age by August 31, 2014
Más detallesMore child support paid + more passed
Child Support and W-2 are working together to better serve Wisconsin families. More child support is paid when families understand the rules. Recent child support policy changes are giving more money back
Más detallesSpanish Version provided Below
Spanish Version provided Below Greater Waltown United Holy Church s Summer Reading and Math Program 706 Belvin Avenue Durham, N. C. 27712 (919) 220-7087 May 3, 2015 Dear Parent/Guardian: Summer can be
Más detallesPortal para Padres CPS - Parent Portal. Walter L. Newberry Math & Science Academy Linda Foley-Acevedo, Principal Ed Collins, Asst.
Portal para Padres CPS - Parent Portal Walter L. Newberry Math & Science Academy Linda Foley-Acevedo, Principal Ed Collins, Asst. Principal (773) 534-8000 Formando su cuenta - Setting up your account Oprima
Más detallesEmployee s Injury Report / Informe de lesión de empleado
Claims Administrative Services Phone: 800-765-2412 Fax: 903-509-1888 501 Shelley Drive Claims Administrative Services, Inc. Tyler, Texas 75701 Our reputation for excellence is no accident. / Nuestro prestigio
Más detallesCPTM. Travel Agent Database Build
CPTM Travel Agent Database Build Table of Contents Purpose Methodology Agent Survey Results USA Regional Office Recap Methodology Gather agency e-mail addresses through the IATA/IATAN Global Source Put
Más detallesNombre Clase Fecha. committee has asked a volunteer to check off the participants as they arrive.
SITUATION You are participating in an International Student Forum. The organizing committee has asked a volunteer to check off the participants as they arrive. TASK As the volunteer, greet the participants
Más detallesAplicación de Vivienda Publica para Ingreso Bajo
PINELLAS COUNTY HOUSING AUTHORITY The Dean S. Robinson Administration Building 11479 Ulmerton Rd., Largo, Florida 33778 Fax (727)585-3891 Rainbow Village Fax (727)489-6457 Lakeside Terrace Fax (727)544-6994
Más detallesEMPLOYER & EMPLOYEE RETIREMENT PLAN TAX CREDITS
EMPLOYER & EMPLOYEE RETIREMENT PLAN TAX CREDITS For employers who set up and maintain retirement plans, the setup costs, annual administrative costs, and retirement-related employee education costs are
Más detallesAdeudos Directos SEPA
Adeudos Directos SEPA Qué es SEPA? La Zona Única de Pagos en Euros (Single Euro Payments Area, SEPA) es un proyecto para la creación de un sistema común de medios de pago europeo. Le permitirá realizar
Más detallesYour HUSKY Health Coverage Category is Changing
Connecticut s Official Health Insurance Marketplace Person ID: , Mailed: Your HUSKY Health Coverage
Más detalles