Request for Invoice
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DATE Request for Invoice Surveys of Enacted Curriculum Annual Member Fee
CCSSO Collaborative Projects are based on a July 1 - June 30 fiscal year. This request will cover membership in the SEC project for the 2009-10 fiscal year ending June 30, 2010. For assistance, please see the back of this form or contact Rolf Blank at (202) 336-7044.
MEMBER FEE (BASIC, OR FEE SET BY PROJECT BUDGET) NAME OF SCASS PROJECT STATE SURVEYS OF ENACTED CURRICULUM $ 18,000 BASIC FEE 09-10
NAME OF ACCOUNT USED PURCHASE ORDER NUMBER
Contact Information PRIMARY CONTACT FOR ACCOUNTING OFFICE NAME
ADDRESS
PHONE ( ) FAX ( ) E-MAIL
A PROGRAM CONTACT: CONTENT OR ASSESSMENT PERSON B PROGRAM CONTACT: CONTENT OR ASSESSMENT PERSON NAME NAME
ADDRESS ADDRESS
PHONE ( ) FAX ( ) PHONE ( ) FAX ( ) E-MAIL E-MAIL
Billing Information SPECIAL BILLING REQUESTS OR ARRANGEMENTS
SPECIAL WORDING ON INVOICE (In addition to the SCASS project name, number, contact person, fiscal year, and fee)
Payment Schedule DATE OF PAYMENT AMOUNT NOTES
PERSON COMPLETING FORM ______DATE AUTHORIZED SIGNATURE
Please Print Name, Sign, and date Send completed requests to: CCSSO SCASS SEC One Massachusetts Ave., NW Suite 700 Washington, DC 20001-1431 (202) 336-7006 Fax (202) 408- 1938 Explanation of the Form for SCASS Project Payments
SCASS Projects are based on a July 1 - June 30 fiscal year.
Name of SCASS Project/Participation Fee/State Surveys of Enacted Curriculum is the name of the Project; fill in the amount of the yearly participation fee based on the core SEC membership annual fee ($22,000) OR the amount committed from your agency based on agreement with the SEC SCASS project; Indicate your state or agency.
Name of State Account Used This might be designated as "Assessment," "Standards Reform." or whatever funding source your state may use.
Purchase Order Number The purchase order number assigned to this project.
Primary Accounting Office Contact Persons This is the person who will receive the invoice and whose name will be listed on the invoice.
Program Contact Persons This will usually be the names of the people who represent your state at the SCASS meetings.
Special Billing Arrangements In some situations, the state's fiscal year or budget process may necessitate a delay in the payment, a splitting of payments, or other deviations from an immediate SCASS payment schedule. Provide an explanation here and indicate your intentions for a payment schedule.
Wording on Invoice This is the information you would like to appear on the Invoice in addition to the SCASS Project Name, Contact Person, Fiscal Year, and Fee.
Payment Schedule When payments need to be split, use this space to indicate the approximate dates and amounts planned in the payment schedule. This will allow CCSSO to anticipate payments appropriately.
Person Completing Form This will usually be one of the persons listed in the state contact information above or a person designated by the supervisor.
Authorized Signature Please print the name and provide the date of authorization. The form should be signed by the person with the authority to approve payment of the fee. This signature will authorize CCSSO to reimburse state representatives for any meetings before the state payment is received and provide assurance that the state will be a member of the project.
For additional information or assistance, please contact:
Rolf Blank Council of Chief State School Officers One Massachusetts Ave., NW, Suite 700 Washington, DC 20001-1431 202 336 7044; Fax 202 408 1938