zilongwang/ReadingBank huggingface dataset:
9. RESEARCH PROJECT SUMMARY IN PORTUGUESE IN ENGLISH 9. SUMMARY OF FUNDING REQUESTED FOR PROJECT (Please, enclose the detailed budget according to FAPESP standards. You can copy the following required values from your filled budget sheet - Excel) FAPESP EXPENSES (separate decimals with a comma) BBSRC EXPENSES (separate decimals with a comma) EXPENSES IN R$ EXPENSES IN US$ EXPENSES IN £ Equipment MPN MPI Consumables MCN MCI Provision for Importation * Services STB STE
Travel Allowance DIP DIE Travel Expenses Other costs OVERHEADS - NOT APPLICABLE FOR THIS STAGE FELLOWSHIPS - NOT APPLICABLE FOR THIS STAGE TOTAL COST (R$) FAPESP (R$/US$) Please indicate the current exchange rate: BBSRC (R$/ £) Please indicate the current exchange rate: Notes: * Provision for Importation (15% of the total budget requested for imported items – Equipment and consumables) 10. JUSTIFICATION: please detail the main costs requested (explain the relevance of these items for the research plan)
Regulatory Contact: (delete as appropriate for study) List applicable numbers from above: Study Nurse: (delete as appropriate for study) List applicable numbers from above: Research Assistant: (delete as appropriate for study) List applicable numbers from above: Data Coordinator: (delete as appropriate for study) List applicable numbers from above: Honest Broker: (delete as appropriate for study) List applicable numbers from above: Statistician: (delete as appropriate for study) List applicable numbers from above:
Contact details of the person(s) responsible for the trial: Post Title Name Department Mobile Number Section C: Human Subjects Involved Expected start date and end date of the clinical trial (from “dd-mm-yyyy” to “dd-mm-yyyy”): From To Age range of human subjects: _________________________________________________________ Total number of human subjects needed: _________________________________________________ Justification of the total number of human subjects needed: Location of the trials: On PolyU campus in the following location(s): Outside PolyU campus in the following location(s): Section D: Declaration by Applicant I will comply with the Code of Ethics for Research Involving Human Subjects and all subjects in the clinical study to this application will be preceded by careful assessment of predictable risks in comparison with foreseeable benefits to
Small Purchase Log Use this form for CSFP and TEFAP purchases with a total aggregate cost of less than the simplified purchase threshold that are not micro-purchases. CE Name: ____________________________ Procurement Year: ________ Technical Specifications Product(s)/Service(s) to Be Procured: Description: Quantity: Delivery Frequency/Location(s): Contractor/ Supplier Information Contractor/Supplier Name & Contact Information: Contractor/Supplier Name & Contact Information: Contractor/Supplier Name & Contact Information: Contact Date: Contact Method: Contact Date: Contact Method: Contact Date: Contact Method: Unit Price: Extended Price: Unit Price: Extended Price: Unit Price: Extended Price: Notes: Notes: Notes: Check if the Contractor/Supplier Was Awarded the Contract Check if the Contractor/Supplier Was Awarded the Contract Check if the Contractor/Supplier Was Awarded the Contract Signature of Person Completing This Form: Date: _____________________________________________________________ _________________
9. environmental Release Not for publication – 10. environmental FATE/EFFECTs Information Not for publication Summary of the chemicals environmental effects Fish toxicity Daphnia toxicity Algal toxicity Other (describe): Other (describe): Result EC50 … mg/L EC50 … mg/L EC50 … mg/L Effects Observed?1 Yes No Yes No Yes No Yes No Yes No Data Source (e.g. study, read across, journal, model) 1 briefly discuss any observed effects in a few sentences below. Discussion of any effects observed: 11. MSDS and Label
Bacterial mutagenicity In vitro genotoxicity In vivo genotoxicity Repeat Dose toxicity toxicity Carcinogenicity Structural alert? Yes No Yes No Yes No Yes No Yes No Yes No Data available? Yes No Yes No Yes No Yes No Yes No Yes No Data Source (study, , read across, journal, model) Effects observed? Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Yes No NA Result (if study conducted) equivocal equivocal equivocal LOAEL = LOAEL = NA = not applicable, i.e. study not conducted Acute Oral Toxicity Dose mg/kg bw Number of Animals Mortality Signs of toxicity Acute Dermal Toxicity Dose mg/kg bw Number of Animals Mortality Signs of local toxicity Signs of systemic toxicity Acute Inhalation Toxicity Concentration <units> Number and Sex of Animals Mortality Signs of toxicity Nominal Actual Eye Irritation Scores Lesion Mean score* Animal no. Maximum Score Maximum Duration of Any Effect Maximum Value at End of Observation Period 1 2 3 Conjunctiva: redness Conjunctiva: chemosis Conjunctiva:discharge Corneal opacity Iridial inflammation *Calculated on the basis of the scores at 24, 48, and 72 hours for EACH animal. Skin Irritation Scores
Giuseppe Pellizzi Prize 2018 [C] Applicant’s CV Form (Please select the Calibri 10 typeface) European curriculum vitae format Personal information Name [Surname, other name(s)] Address [House number, street name, postcode, city, country] Telephone ++ Fax ++ E-mail Nationality Date of birth [Day, month, year] Work experience [Add separate entries for each relevant post occupied, starting with the most recent] • Dates (from – to) [Day, month, year] • Name and address of employer • Type of business or sector • Occupation or position held • Main activities and responsibilities Education and training [Add separate entries for each relevant course you have completed, starting with the most recent] • Dates (from – to) [Day, month, year] • Name&type of organisation providing education and training • Principal subjects/occupational skills covered • Title of qualification awarded • Level in national classification (if appropriate) Personal skills and competences [Acquired in the course of life and career but not necessarily covered by formal certificates and diplomas] Mother tongue Other languages [Specify languages] • Reading skills [Indicate level: excellent, good, basic] • Writing skills [Indicate level: excellent, good, basic] • Verbal skills [Indicate level: excellent, good, basic] Additional information [Include here any other information that may be relevant, for example contact persons, references, etc.] Annexes [List any attached annexes with particular attention to scientific publications related to the PhD degree]
[Please state details of any mutual credit, mutual debts, or other mutual dealings between the corporate debtor and the creditor which may be set-off against the claim]. Date: Place: (Signature of the claimant) VERIFICATION I, [Name] the claimant hereinabove, do hereby verify that the contents of this proof of claim are true and correct to my knowledge and belief and no material fact has been concealed therefrom. Verified at … on this …… day of ………., 20… (Deponent's signature)
Verified at … on this …… day of ………., 20… Deponent's signature [Note: In the case of company or limited liability partnership, the declaration and verification shall be made by the director/manager/secretary and in the case of other entities, an officer authorised for the purpose by the entity].
About the F19 application form Approval of a greenfields agreement made under subsection 182(3) of the Act About greenfields agreements Greenfield agreements involve a genuinely new enterprise that one or more employers are establishing or propose to establish and who have not yet employed people necessary for the normal conduct of the enterprise. Such agreements may be single or multi-enterprise agreements. More information about the process that must be followed to make a new enterprise agreement can be found in the Commission's . There are two ways a greenfields agreement can be made: Under section 182(3) of the Fair Work Act 2009, a single-enterprise or multi-enterprise agreement that is a greenfields agreement is made when the agreement is signed by each employer and employee organisation that the agreement is expressed to cover. Under section 182(4) of the Fair Work Act 2009, a single-enterprise agreement that is a greenfields agreement is made if: there has been a 6 month notified negotiation period for the agreement, which has ended each employee organisation that was a bargaining representative has been given a reasonable opportunity to sign the agreement, and the employer or employers that were bargaining representatives for the agreement apply to the Commission for approval of the agreement. The agreement is made when the application is made to the Commission. Who can use this form Use this form if: you are an employer or a bargaining representative for a greenfields agreement and a greenfields agreement has been made under section 182(3) of the . Note: If the greenfields agreement has been made under section 182(4) of the Fair Work Act 2009—complete Form 21A. If the agreement is not a greenfields agreement—complete Form F16. Lodgment and service of your completed form 1. Within 14 calendar days after the agreement is made, you must lodge with the Commission: this application and a copy of the agreement signed in accordance with regulation 2.06A of the and if the application is being made by a bargaining representative appointed by the employer—a copy of the written instrument of appointment and a Form F20—Employer’s statutory declaration in support of an application for approval of a greenfields agreement made under subsection 182(3) and a Form F21—Statutory declaration of employee organisation in relation to an application for approval of a greenfields agreement made under subsection 182(3).
pay such costs. Customer further agrees to pay all foreign, federal, states, and local taxes, if applicable, to Customer’s access to, use, or receipt of the Service. Payment Schedule Payment Due Upon Amount Startup Fee Contract Signature aaS Fees Service Year 1 – Q1 Completion of IQ Scripts. aaS Fees Service Year 1 – Q2 First day of next 90 days of agreement aaS Fees Service Year 1 – Q3 First day of next 90 days of agreement aaS Fees Service Year 1 – Q4 First day of next 90 days of agreement aaS Fees Service Year 2 – Q1 First day of next 90 days of agreement aaS Fees Service Year 2 – Q2 First day of next 90 days of agreement aaS Fees Service Year 2 – Q3 First day of next 90 days of agreement aaS Fees Service Year 2 – Q4 First day of next 90 days of agreement aaS Fees Service Year 3 – Q1 First day of next 90 days of agreement aaS Fees Service Year 3 – Q2 First day of next 90 days of agreement aaS Fees Service Year 3 – Q3 First day of next 90 days of agreement aaS Fees Service Year 3 – Q4 First day of next 90 days of agreement aaS Fees Service Year 4 – Q1 First day of next 90 days of agreement aaS Fees Service Year 4 – Q2 First day of next 90 days of agreement aaS Fees Service Year 4 – Q3 First day of next 90 days of agreement aaS Fees Service Year 4 – Q4 First day of next 90 days of agreement Total The monthly recurring charges shown above do not include the usage-based backup and storage service fees, which are calculated, reported and charged monthly in arrears. Charges are based on the actual volumes of data backed up in the previous month and volumes retained from previous months. Pricing for backup services includes restores for the purpose of data recovery only. Data recovery is defined as the restoration of data that has been lost or corrupted due to system crashes, erroneous deletions, or other unplanned events from a recent copy of the data
Service Year 1 Q1-Q4 24x7 Emergency Coverage 1 N/A First day of next 90 days of agreement Completion of 90 days of agreement Service Year 2 Service Year 2 - Q1 MP-160 1 160 First day of next 90 days of agreement Completion of 90 days of agreement Service Year 2 - Q2 MP-160 1 160 First day of next 90 days of agreement Completion of 90 days of agreement Service Year 2 - Q3 MP-160 1 160 First day of next 90 days of agreement Completion of 90 days of agreement Service Year 2 - Q4 MP-160 1 160 First day of next 90 days of agreement Completion of 90 days of agreement Service Year 2 Q1-Q4 24x7 Emergency Coverage 1 N/A First day of next 90 days of agreement Completion of 90 days of agreement Service Year 2 Q1-Q4 Additional Timezone Spt 2 N/A First day of next 90 days of agreement Completion of 90 days of agreement Service Year 3
3.2 Why was the dismissal unfair? Using numbered paragraphs, describe the relevant facts and circumstances and specify why you say the dismissal was unfair. This should include: your response to any reasons for dismissal given by the employer whether you were counselled or warned by the employer of any deficiencies in your performance or conduct and the circumstances of each counselling session or warning why you believe the dismissal was unfair. Attach additional pages if necessary. Disclosure of information The Commission will provide a copy of this application and any attachments to the other parties in this matter. This includes: the employer any legal representatives. Consent to contact by researchers The Commission undertakes research with participants in unfair dismissal matters to ensure a high quality process. Some research may be undertaken by external providers. Do you consent to the contact details provided on page 1 of this form being provided to an external provider of research services for the sole purpose of inviting you to participate in this research? [ ] Yes [ ] No
Your representative These are the details of the person or business that is representing you. Name of person Organisation Postal address Suburb State or territory Postcode Phone number Fax number Email address The other party These are the details of the other party covered by the instrument. Title [ ] Mr [ ] Mrs [ ] Ms [ ] Other please specify: First name(s) Surname Postal address Suburb State or territory Postcode Phone number Fax number Email address If the other party is an organisation please also provide the following details Legal name of organisation Trading name of organisation ABN/ACN Contact person 1. Preliminary 1.1 What is the industry of the employer? Please specify the industry.
7. Notified details of the resulting situation on the date on which the threshold was crossed or reached: A: Voting rights attached to shares Class/type of shares ISIN code (if available) Number of voting rights % of voting rights Direct (Art. 122 sec. 1 BACM) Indirect [Art. 122 sec. 2 subsec. (a) to (g) BACM] Direct (Art. 122 sec. 1 BACM) Indirect [Art. 122 sec. 2 subsec. (a) to (g) BACM] Subtotal A B.1: Financial Instruments with right to acquire shares acc. to Art. 122 sec. 2 subsec. (h) BACM Type of financial instrument Expiration date Exercise/ Conversion Period Number of voting rights that may be acquired if the instrument is exercised/ converted % of voting rights Subtotal B.1 B.2: Financial Instruments with similar economic effect acc. to Art. 122 sec. 2 subsec. (i) BACM Type of financial instrument Expiration date Exercise/ Conversion Period Physical or cash settlement Number of voting rights % of voting rights Subtotal B.2
4. SAFETY TRAINING In the following table, provide the names of Drexel University personnel involved in this study (including the Principal Investigator). All personnel must have completed BioRAFT-based laboratory safety training within the last 12 months. Please note that: Because the PI is responsible for all biosafety aspects of the project, the PI must complete all relevant laboratory training. When entering information in the “Tasks to be Performed” column, be specific as to the major tasks to be performed. For example, a project involving the collection of patient blood samples for cytokine analysis might include “blood collection,” “sample processing,” and “ELISAs” as tasks. The training completion date should be entered in the mm-dd-yyyy format. If the “Shipping Biological Materials” course was completed through BioRAFT within the last 12 months, check the appropriate box(es) for each person listed in the table. To complete laboratory safety training, go to and log in using your DrexelOne user ID and password. (Please note: If you are using MS Word on a PC, you will likely need to copy the link directly into your web browser. This is a MS Word issue with no work-around.) Name of investigator, student, or coordinator Tasks to be performed (e.g., sample collection, processing/shipping) Date of BioRAFT training Biohazard Material Shipping Training PI 5. STUDY INFORMATION Answer the following questions about studies involving laboratory analyses or experimentation involving specimens collected from human study participants. a. Describe the specimens to be collected from study participants. b. Will the specimens be collected from study participants known or demonstrated to be infected with human pathogens? If your answer is Yes, list the pathogen(s). Note: All human specimens must be handled using Standard Precautions regardless of the participant pathogen status. Yes No c. Will the specimens be tested after collection for the presence of selected human pathogens? If your answer is Yes, list the pathogens to be detected. Note: All human specimens must be handled using Standard Precautions regardless of the pathogen testing results. Yes No d. If you answered Yes to either question 5b or 5c above, indicate the Risk Groups(s) of the
Form IDCH-1 Empowering Dreams for the Future INFORMATION GUIDE FOR COLLEGE CREDIT NOW The purpose of this exhibit is to provide school counselors curricula guidelines to assist in the implementation of Administrative Rule IDCH-R (Dual/Joint Enrollment Programs). Course taken through College Credit Now that are higher than courses which receive the 1.0 quality point at the high school will also receive the 1.0 quality point. These courses are: In order to earn extra quality points in a College Credit Now approved college-level course, the student must have taken the appropriate high school course: Language Arts Math Calculus Math Statistics Science Biology Science Chemistry Science Physics Social Studies US History Social Studies World History Social Studies Electives Social Studies Government Social Studies Economics Foreign Language AP Literature & Composition AND/OR* AP Calculus BC AND/OR* AP Statistics OR* AP Biology OR* AP Chemistry OR* AP Physics B AND/OR* AP US History OR* AP World History OR* AP Psychology AP Government & Politics OR* AP OR* AP Language AND/OR* Literature AP Language & Composition OR* AP Calculus AB AND/OR* IB Mathematics Higher Level IB Biology Higher Level IB Chemistry Higher Level AP Physics C (Mechanics) AND/OR* IB World Topics/20th Century History Higher Level AP Human Geography AP OR* in the following Languages: IB English A Higher Level Multivariable Calculus OR* AP Physics C Electricity and Magnetism OR* AP European History IB Economics Higher Level Spanish, French, German, Chinese, Japanese, Latin Italian IB Mathematics Higher Level IB Physics Higher Level OR* IB Spanish Higher Level, IB French Higher Level *Highest level of class available is determined at the local school. If the course is available at the local school and offered, then the student must take the highest level of course available at the local school in order to get the extra quality point.
Form IHF-5 Empowering Dreams for the Future GRADUATION REQUIREMENTS: STUDENTS ENROLLING IN THE NINTH GRADE IN THE 1995-1996, 1996-1997 & 1997-1998 SCHOOL YEARS Graduation Requirements IHF (3) 5/9/07 This policy becomes effective with enrolling ninth-grade students in school year 1995-1996. Requirements for regular high school graduation from the shall meet or exceed all standards as set forth by the State Board of Education and the Southern Association of Colleges and Schools. I. PURPOSE This policy specifies programs of study and lists specific courses that meet core, required or elective credits for students. II. DEFINITIONS A. Applied Mathematics I - a hands-on laboratory course defined by Quality Core Curriculum (QCC) objectives that utilizes the content of units A, B, C, and 1-15, the related materials, and the methodologies developed by the Center for Occupational Research and Development (CORD). B. Applied Mathematics II - a hands-on laboratory course defined by QCC objectives that utilizes the content of units 16-33, the related materials, and the methodologies developed by the Center for Occupational Research and Development (CORD). C. Carnegie unit - one unit of credit awarded for a minimum of 150 clock hours of instruction. D. Carnegie unit, summer school - one unit of credit awarded for a minimum of 120 clock hours of instruction. E. College Preparatory (CP) Program - a program of study requiring 21 Carnegie units as specified by the Georgia Board of Education. Completion of this program is signified by a College Preparatory Diploma. F. Center for Occupational Research and Development (CORD) - a consortium of states,
Rem#: Part IV: Standards for Soil Remediation Check either #1, #2, or #3 below to indicate the final assessment of release determination and investigation completed at the subject property for all potential releases applicable to the pertinent date of this verification. A. Release Determination and Investigation 1. No Releases to Soil. All potential releases to soil at the subject portion of the business establishment – applicable to the pertinent date of this verification - have been investigated in accordance with prevailing standards and guidelines, including the SCGD (Phase II ESA) or other equal alternative approach, and there were no detected concentrations of a substance in soil. Subsequent to previous verification identified in Part III. A. above. The relevant findings of all “No-Release” determinations are presented in the Verification Report. If #1 checked, skip to below. 2. Releases to Soil – No Remediation or other Compliance Measure Required. Substances, associated with business operations and applicable to the pertinent date of this verification, were detected in soil at the subject portion of the business establishment, but all detected concentrations of substances in soil were less than criteria before remediation or initiation of other compliance measure. The nature and distribution of all releases at the subject portion of the business establishment and applicable to the pertinent date of this verification have been characterized in accordance with prevailing standards and guidelines, including the SCGD (Phase III Investigation) or equal alternative approach. Releases subsequent to previous verification identified in Part III. A. above. If #2 is checked, skip to below. 3. Releases to Soil –Remediation or other Compliance Measure Required Substances in soil at the subject portion of the business establishment and associated with a release applicable to the pertinent date of this verification exceeded criteria at any time, Complete the information in the box below. Criterion Exceeded Category of COC Compliance Measure PMC Non-chlorinated VOCs Excavation & Removal GA Chlorinated VOCs Excavation / On-site Re-use GB Metals Engineered Control DEC PAHs ELUR Res SVOCs In-situ I / C PCBs RSR Exemption Petroleum Hydrocarbons Use of RSR Alternatives Pesticides / Herbicides Use of 95% UCL Other
Activity Type SCA Counseling/Advising/ Academic Planning/Career Counseling SFA Financial Aid Counseling/Advising PCA Parents - Counseling/Advising (Family) SCM Comprehensive Mentoring Services STU Tutoring-List Type Note: All individual parent contacts are PCA. GEAR UP Staff Name School Name Date Student Name Total Time with Student Type # of family members present or N/A Notes Entered in Portal
5. Once you have completed all the relevant fields, press the Request Access button. The following message from the system will be displayed. 6. Once you have submitted your request for access and it has been processed, you will receive an email confirming or denying your access to DSC-SO. Hint: In most cases this email is automated and should arrive within 10 minutes. In some instances, for security purposes, someone within your organisation (DSO) may need to review the request. This generally occurs when you are not using your organisation’s domain as part of your email address. In this instance you will not receive an email until it has been manually processed. 7. In the event you are denied access, you will need to discuss this further with the individual identified in the email who works within your organisation who denied your access. The Commission will be unable to assist you in this instance. When access has been granted you will receive an email as follows. Follow the instructions on the email that reads - “To finish setting up your account please click here and follow the instructions”. 8. Upon clicking the link from the email, the activation screen will be displayed.
2017 – 2018 Ten Month Tuition and Fee Schedule Grade Application & I-20 Processing Fee (Non-Refundable) Matriculation Fee (Yearly One-Time Fee) Technology Fee (Yearly One-Time Fee) International Student Fee (Yearly One-Time Fee) Tuition Per Month (for 10 months) 6th – 11th $1,500 $845 $300 $1,000 $1,100 TOTAL OF YEARLY EDUCATIONAL FEES: $14,645 Tuition may be paid monthly, by semester, or yearly. HOUSING/HOME-STAY/BOARDING ESTIMATED for one academic term (10 Months) as set by = $15,000 Must be paid by semester or yearly. Other arrangements must be submitted in writing and approved by Texas Christian School Administration.
#’s or Site-Wide Trihalomethanes resulting from releases of drinking water from public water supply system, or Metals, petroleum hydrocarbons, or semi-volatile substances, provided such pollution is due to: Incidental release due to normal operation of motor vehicles A result of normal paving and maintenance of pavement 3. Background Groundwater Quality 22a-133k-3(a)(1)(B) and k-3(a)(2) Release Area (RA) ID #’s or Site-Wide Groundwater in GA area meets Background Groundwater Quality 22a-133k-3(a)(2) Background Water Quality not required (see 4a. below) 22a-133k-3(d) Exemption from Background due to Technical Impracticability 22a-133k-3(e)(1) Lot: Block: Map: Town: 4. Compliance with Background 22a-133k-3(g)(2)(B) Release Area (RA) ID #’s or Site-Wide Sampling locations are representative of plume, and Analytical results ≤ Background concentration for groundwater OR (i) 12 consecutive monthly samples from each sampling location are ≤ 95% UCL (ii) 4a. Compliance with Background not Required 22a-133k-3(d)(1) or (d)(2) Release Area (RA) ID #’s or Site-Wide GWPC, not Background, is applicable at site (All of the following must apply) 22a-133k-3(d)(1) The background concentration is ≤ GWPC; A public water distribution system is available within 200 feet of the subject parcel, parcels adjacent thereto, and any parcel within the areal extent of the plume; Such plume is not located in an Aquifer Protection Area; AND Such plume is not located within the area of influence of any public water supply well. Groundwater remediation to Background not required (All ofthe following must apply) 22a-133k-3(d)(2) All substances in plume ≤ GWPC prior to remediation The areal extent of the plume that exceeds applicable criteria is not increasing over time, The concentration of substances is not increasing over time,
the information in the box below and the rest of Section B below. Criterion Exceeded Category of COC Compliance Measure PMC Non-chlorinated VOCs Excavation & Removal GA Chlorinated VOCs Excavation / On-site Re-use GB Metals Engineered Control (via previously filed Form III that has not been closed) DEC PAHs ELUR (via previously filed Form III that has not been closed) Res SVOCs In-situ (via previously filed Form III that has not been closed) I / C PCBs RSR Exemption Petroleum Hydrocarbons Use of RSR Alternatives Pesticides / Herbicides Use of 95% UCL Other The Form IV Supporting Verification Report (VR) documents and explains how the Soil Remediation Standards were achieved at each release area. Compliance Measures 1. Excavation Remediation excavation of polluted soil was conducted to achieve compliance Applicable Release Area (RA) ID #’s Remedial excavation discussed in Section , page in the VR. Polluted soil meeting definition of hazardous waste per CGS 22a-449(c) was located on site and was treated, stored, disposed, and/or transported in conformance with RCRA section 22a-449(c)-101 through 110. 22a-133k-2(h)(1) The Commissioner authorized the disposal of polluted soil as special waste, as defined in RCRA section 22a-209-1 22a-133k-2(h)(2) Approval date(s): Copy(s) of Approval(s) must be attached to VR Polluted soil reused on-site 22a-133k-2(h)(3) Total volume excavated soil reused on site: Polluted soil reused off-site (Commissioner approval via previously filed Form III that has not been closed) Approval date(s): 22a-133k-2(h)(3) Copy(s) of Approval(s) must be attached to VR Total volume of excavated soil removed from site: Lot: Block: Map: Town: 2. Engineered Control (via previously filed Form III that has not been closed)
10. Compliance with VolC 22a-133k-3(g)(2)(D) Release Area (RA) ID #’s or Site-Wide Compliance with VolC in Groundwater (i) Sampling locations are representative of plume, and Analytical results ≤ applicable VolC, as determined by 22a-133k-3(c) OR Compliance with VolC in Soil Vapor (ii) Sampling locations and frequency are representative of soil vapor, including seasonal variability, and Analytical results ≤ applicable VolC Lot: Block: Map: Town: 11. Other Provision Release Area (RA) ID #’s or Site-Wide Application of DEEP “Policy on Up-Gradient Contamination” (8/28/97) Part VI: Receptors Groundwater Class: Depth to Water Table: Surface Water Class: Name of and Distance to nearest downgradient surface water body: Abutting land uses (check all that apply): Industrial Commercial Residential Agriculture Sensitive receptor land use within 500 feet of site (check all that apply): school childcare facility healthcare facility recreational residential Sensitive Water Resource (e.g. shellfish beds, public fishing areas, significant wetland complexes, public water supplies) other (specify): Did any on-site release have the potential to impact an Ecological Receptor Yes No If yes, were the potential ecological exposure pathways, where contaminants could affect aquatic and terrestrial life, evaluated Yes No If yes, what level of evaluation was completed? Scoping Screening Risk Assessment If yes, was the ecological receptor impacted by an on-site release? Yes No Was the impact mitigated? Yes No If groundwater impacted, indicate number of water supply wells within 500 feet of site boundaries: Has a groundwater plume that originated on-site migrated off-site? Yes No
Form JGCD-9 Empowering Dreams for the Future HYPODERMIC INJECTION REQUEST From Licensed Health Care Provider (Legal Prescriber) Date: Student’s Name: Name of Medication Dosage Route Time Student requires the injection during school hours. Student has been instructed by me in the proper use of the above medication. In my professional opinion MAY ADMINISTER this medication himself/herself. OR Student has been instructed by me in the proper use of the above medication. In my professional opinion NEEDS ASSISTANCE from the licensed school nurse. Type of assistance student requires for administering medication (observe, measure, etc.): Discontinue medication on: Special instructions: Printed Name of Legal Prescriber: Phone: Signature of Legal Prescriber: Please note: One medication per form
Department of Trade and Taxes Government of NCT of Delhi Form DVAT 01 [See Rule 5(2)] PART - A Application For Opting For Composition Scheme 1. TIN 2. Full Name of Applicant Dealer 3. Nature of Business Trader Manufacturer Works Leasing Others (Tickall applicable) Contractor (specify) _______ 4. Year for which composition scheme is sought* - * hereinafter referred to as “current year” 5. Turnover in the preceding year (Rs.) 6. Estimated Turnover in the current year (Rs.) 7. Tax Payable on Opening Description* Tax Payable (Rs.) Stock lying at the beginning (i) Trading Stock of the current year (Iii) Raw material [u/s 16(9)] (iii) Packaging Material (iv) Finished Goods Total (* Please complete Annexure 1) 8. Details of Tax paid calculated as per (7) above Description (i) Amount of tax paid* (Rs.) (iii) Date of Deposit / / dd mm yyyy (iii) Challan No. if any (* Please attach original challan / proof of deposit)
Form KG-3a Empowering Dreams for the Future LASSITER CONCERT HALL FEE SCHEDULE CONCERT HALL RENTAL OPTIONS CCSD SCHOOL USERS **TAX EXEMPT NON-PROFIT ORGANIZATION ALL OTHER USERS *CONCERT HALL (seats 1,000) $0 $100 Per Hour $350 Per Hour REHEARSAL $0 $50 Per Hour $200 Per Hour LOAD IN/SET UP $0 $50 Per Hour $50 Per Hour SECURITY (depends on number of guests) $35 Per Hour/Per Officer $35 Per Hour/Per Officer $35 Per Hour/Per Officer CUSTODIAL SERVICES $25 per hour or time and a half of regular salary plus employer paid fringe benefits whichever is greater $25 per hour or time and a half of regular salary plus employer paid fringe benefits whichever is greater $25 per hour or time and a half of regular salary plus employer paid fringe benefits whichever is greater RISERS $0 $100 $150 FRONT RECEPTION ROOM $0 $50 Per Hour $75 Per Hour SECURITY DEPOSIT (refundable) $0 Must pay for damages $250 Must pay for damages $500 Must pay for damages HOLD DEPOSIT (non-refundable) $0 $250 $500 GRAND PIANO $0 $100 Per Event $100 Per Event UPRIGHT PIANO or KEYBOARD $0 $40 Per Piece/Per Event $40 Per Piece/Per Event ADDITIONAL TUNING $100 Extra Per Event $100 Extra Per Event $100 Extra Per Event ACOUSTIC SHELLS $0 $100 Per Event $100 Per Event SKIRTED TABLE $10 Per Table/Per Event $10 Per Table/Per Event $10 Per Table/Per Event MICROPHONE $0 $20 Per Additional Mic. $20 Per Additional Mic. TECHNICIANS $25 Per Tech/Per Hour $25 Per Tech/Per Hour $25 Per Tech/Per Hour PROJECTOR and SCREEN (may require technician at hourly rate) $0 $60 Per Event $60 Per Event AMPHITHEATRE (outside) $0 $50 $100 * Concert Hall fee includes: Green Room, Dressing Rooms, One Supervisor, One Technical Director for four hours per day, One Microphone, Utilities, and Public Restrooms. ** Tax exempt non-profit organization; 501(C)(3)
Form D: Clinical log of all supervised practice Name: ……………………………………………………. Index Child Id Start Date End Date No: of sessions Total hours seen Gender Age Problem type Outcome drop out/completed VIG1 VIG2 VIG3 VIG4 VIG5 VIG6 VIG7 IP1 IP2 IP3 Gp1 Total number of hours of supervised practice ……….. Signed (Trainee) …………………………………………………….…… Date ………………… Signed (University Supervisor) ………………………………….……… Date. ………………… Signed (Workplace Supervisor) ……………………………………….… Date ……………….…
Weekly Feedback Document: Group 1 Group 2 Week 1 / Unhelpful Neutral Helpful Very helpful Week 8 / Unhelpful Neutral Helpful Very helpful Content Content Video Video Teaching Teaching Discussion Discussion Week 2 / Unhelpful Neutral Helpful Very helpful Week 9 / Unhelpful Neutral Helpful Very helpful Content Content Video Video Teaching Teaching Discussion Discussion Week 3 / Unhelpful Neutral Helpful Very helpful Week 10 / Unhelpful Neutral Helpful Very helpful Content Content Video Video Teaching Teaching Discussion Discussion Week 4 / Unhelpful Neutral Helpful Very helpful Week 11 / Unhelpful Neutral Helpful Very helpful Content Content Video Video Teaching Teaching Discussion Discussion Week 5 / Unhelpful Neutral Helpful Very helpful Week 12 / Unhelpful Neutral Helpful Very helpful Content Content Video Video Teaching Teaching Discussion Discussion Week 6 / Unhelpful Neutral Helpful Very helpful Week 13 / Unhelpful Neutral Helpful Very helpful Content Content Video Video Teaching Teaching Discussion Discussion Week 7 / Unhelpful Neutral Helpful Very helpful Week 14 / Unhelpful Neutral Helpful Very helpful Content Content Video Video Teaching Teaching Discussion Discussion
CME (Clinical Education) (Includes: attending rounds, morning report, noon conferences, grand rounds, consultation rounds, etc.) CME (Clinical Education) Program Hours/Year PRECEPTING (Includes: laboratory supervision, supervision in clinic, etc.) Precepting Activity Preceptee Group (Resident, Fellow, Post-doc, etc.) Preceptee (s) Hours/Year OTHER TEACHING ACTIVITY (tutoring, dental students, etc.) Teaching Activity Role (Course Director, Instructor, Lecturer, Teaching Assistant, Other (specify)) Institution Contact Hours/Year Lect. Sm. Grp. Lab MENTORSHIP Mentorship Activity Mentee Group (Junior Faculty, Post-doc, Medical Student, etc.) Mentee (s) TOTALS Hours/Year Lect. Sm. Grp. Lab Clinical Precepting
Please list publications for 1/1/2018 – 12/31/2018 then list publications for 1/1/2017 – 12/31/2017 PUBLICATIONS Manuscript Citation Type (Article, Book/Chapter, Case Report, etc.) Peer Reviewed (Y/N)? PRESENTATIONS Presentation Type (Scientific, Clinical, Other (specify)) Peer Reviewed (Y/N)? Invited or Accepted? Date & Location Use additional sheets as necessary ACADEMIC MERIT DATA FORMS Calendar Year for the 12-month period 1/1/2018 – 12/31/2018 Required Form: Organizations, Boards, Reviewer, and Community Worksheet FACULTY NAME: DEPARTMENT: Please include only information for Calendar Year for the 12-month period 1/1/2018 – 12/31/2018 Use additional sheets as necessary Include any additional information you feel is relevant COMMITTEES, BOARDS, AND SCIENTIFIC ORGANIZATIONS Name of Committee, Board, or Scientific Organization Role Hours/Year UCHC/ External Remarks
By signing this form, I declare that I am entitled to sign it under the applicable law: Name: Signature: FEE CALCULATION SHEET (a) INSTRUCTIONS TO DEBIT FROM A CURRENT ACCOUNT The International Bureau is hereby instructed to debit the required amount of fees from a current account opened with the International Bureau (if this box is checked, it is not necessary to complete (b)). Holder of the account: Account number: Identity of the party giving the instructions: (b) AMOUNT OF FEES Basic fee (653 Swiss francs) Where applicable, surcharge for the grace period (326.50 Swiss Francs) Complementary and supplementary fees: Number of designations for which complementary fee is applicable x Complementary fee 100 Swiss francs Total amount of the complementary fees = => Number of classes of goods and services beyond three x Supplementary fee 100 Swiss francs Total amount of the supplementary fees = => Individual fees (Swiss francs): Designated Contracting Parties Individual fee Designated Contracting Parties Individual fee Total individual fees => Grand total (Swiss francs) (c) METHOD OF PAYMENT Identity of the party effecting the payment: Payment received and acknowledged by WIPO WIPO receipt number Payment made to WIPO bank account IBAN No. CH51 0483 5048 7080 8100 0 Crédit Suisse, CH-1211 Geneva 70 Swift/BIC: CRESCHZZ80A Payment identification dd/mm/yyyy
MODULE WITHDRAWAL FORM MW 17-18 Please contact the Quality Enhancement Office for guidance completing this form on This form is available to download from NOTE: If you need to remove these modules from a current programme, you will need to complete a PMAF form. If you wish to withdraw a whole programme, please complete Appendix 1 of the programme withdrawal form instead. Reason for withdrawal: Confirmations By completing the documentation the school confirms the following, these modules: are not attached to currently running programmes should be withdrawn in their entirety (i.e. includes all existing CRNs) do not need to remain active for resits after the effective withdrawal date Level Subject Code* Module Code* CRN Title Credits Semester With Effect From: ADA Signature: Date: *Completed by Quality and Enhancement Office, but can be found on Module Specifications.
Table of Contents I. Proposal Background and Summary Title and Actions Implementation Term Summary College Strategic Priorities Curriculum Collaborations Cost Analysis Articulation II. Program Information Framework Type School Identifier Labor Market Data Access Assessment Scores Support Occupational Completion Points (Clock Hour Only) Impact III. Program Accreditation Southern Association of Colleges and Schools Commission on Colleges (SACSCOC) Assessment SACSCOC Timeline School Specialized Assessment IV. Program Funding and Reporting Financial Aid Financial Aid Assessment Gainful Employment Gainful Employment Assessment V. Program Page College Catalog Layout Recommended Course Sequence by Term VI. Course Information Assignment Identifier Eligibility Impact VII. Course Outline College Layout Learning Outcomes and Assessment VIII. Addenda Faculty Support (Optional) Program Advisory Committee Meeting Minutes Program Inactivation (Notice to Students, District Board of Trustees Item and SACSCOS Approval) IX. Signatures Obtained by Proposal Originator(s) Prior to Submission to Curriculum Services Obtained by Curriculum Services on behalf of Proposal Originator(s) Faculty Member Instructional Program Manager or Department Chair Director or Dean Technical/Quality Review SACSCOC Liaison Associate Provost or Associate Vice President or Executive Director or Vice President of FSCJ Online and Workforce Education Curriculum Committee Chair Provost/Vice President of Academic Affairs
Office of Curriculum Services Technical and Quality Review Provisions Technical Review Complete Initials Date Quality Review Complete Initials Date Comments SACSCOC Accreditation Liaison Name(s) Dr. Marie F. Gnage Provisions Does not constitute a substantive change; no further information required. Possibly constitutes a substantive change; liaison will request further information. Constitutes a substantive change; liaison will request further information. Comments Signature Date The SACSCOC Accreditation Liaison must review to determine if the proposal constitutes a substantive change that is a significant modification or expansion in the nature and scope of an accredited institution. See Program Accreditation for further information. Associate Provost –or– Associate Vice President –or– Executive Director –or–Vice President of FSCJ Online and Workforce Education Name(s) Title(s) Provisions Support Do Not Support Support with Conditions Noted Comments Signature Date
Form No. 19 [See rule 86] [Heading as in form no 16] LLP Petition No …….. of 20…… ………………………….Petitioner LLP Application No……….. of 20….. Summons for directions Let all parties concerned attend the Member in chambers on ….. day, the ….. day of …..20….. at o’clock, on the hearing of an application by the above named petitioner that a day may be fixed for the hearing of the petition above-mentioned for ….. (purpose) presented on the …. day of….20… and that directions may be given as to the advertisement of the petition and the persons (if any) on whom the petition is to be served. Dated this ….. day of….20…. Authorized Representative for petitioner Registrar of Tribunal This summons was taken out by Shri ……….. , Authorized Representative for the petitioner, and will be supported by the affidavit of ……. [Note : it is not intended to serve this summons on any person.]
Tribunal], a true copy of the above-mentioned petition, and the postal voucher and the acknowledgment received in respect of the same are annexed hereto. 5. The copy served is a copy of the said petition now produced and shown to me marked `A’. Solemnly affirmed, etc.
FORM NO. 40 [See rule 132] [Heading as in form no 16] LLP Petition No……… of 20…….. LLP Application No……………. of 20…… Report of the Liquidator under rule 132 read with rule 34 The Liquidator, in pursuance of rule 132 read with rule 34, hereby submit his report to the NCLT---Bench as follows:- (A)Assets I. Assets specifically mortgaged/pledged or having fixed charge (excluding floating charge) Book value Estimated realizable values Due to secured creditors and workmen Deficiency ranking as unsecured Estimated Surplus Freehold Property Leasehold Property Plant & Machinery Furniture, fittings etc Inventories Other assets ………………… ………………… Rs. Rs. Rs. Rs. Rs. Rs. II. Assets not specifically mortgaged/pledged etc. Book Value (Rs.) Estimated realisable values (Rs.) Balance at Bank Cash in hand Investments Debtors/Trade receivables Loans & Advances Inventories Freehold Property
Form No. 52 [See rule 163] [Heading as in form no 16] LLP Petition No……… of 20…….. Certificate of final settlement of the list of Partners Pursuant to the Limited Liability Partnership Act, 2008 and the rules made thereunder, I….. the undersigned, being the Liquidator of the above-named LLP hereby certify that the result of the settlement of the list of partners of the above-named LLP so far as the said list has been settled up to the date of this certificate is as follows : Serial No in the list. Name and Address Form/ Nature of contribution Amount of contribution Contribution 1 2 3 4 5 Amount of contribution upto the date of commencement of winding up Amount contributed after the date of commencement of winding up Total Outstanding contribution 6 Amount of contribution outstanding upto the date of commencement of winding up Amount of contribution outstanding after the date of commencement of winding up Total Dated this……. Day of….20…. Sd/- Liquidator
Form No. 66 [See rule 208] [Heading as in form no 16] LLP Petition No……… of 20…….. LLP Application No. …………. of 20…… Liquidator ---- Applicant Before the Hon’ble Member Mr…………… Dated…………. Order for payment of amount due from Partner Upon the application of the Liquidator of the above-named LLP and, the affidavit of …..filed the….. day of….20……. and the affidavit of the Liquidator filed the ……. Day of…..20……, it is ordered: That Shri ………of etc., (or Shri ……….., the legal representative of Shri ……………., late of….…. etc. deceased), one of the partners of the said LLP or, if against several partners, that the several persons named in the second column of the schedule to this order, being respectively partners of the said LLP do on or before the …… day of……20….. pay to the Liquidator of the said LLP at his office, the sum of Rs…….. (If against the legal representative add, out of the assets of the said Shri …….deceased in his hands as such legal representative as aforesaid), or if against several partners, the several sums of money set opposite to their respective names in the fifth column of the said schedule hereto, being the amount(s) due from the said Shri……………, or Shri ………………, or the said several persons respectively in respect of …… And it is further ordered that the said Shri …………., or Shri …………….. or the said several persons do also pay interest at the rate of ……… per cent per annum on the said amount(s) specified in the fifth column of the said schedule from this date to the date of payment. SCHEDULE (to be included where there are two or more partners) No. Name and description Address Outstanding Amount of contribution Total Amount due 1 2 3 4 5
Dated this …. day of….20……. ( By the NCLT…………Bench ) Registrar of Tribunal Note: The copy for service of the above order must bear the following endorsement:- “If you, Shri ………………neglect to obey this order by the time mentioned therein you will be liable to process of execution for the purpose of compelling you to obey the same”.
Form No. 79 [See rule 233] [Heading as in form no 16] LLP Petition No……… of 20…….. Disclaimer of Lease* Pursuant to an order of the NCLT……….. Bench dated the ………. day of…….. 20….. I, the undersigned, the Liquidator or LLP Liquidator of the above-named LLP, hereby disclaim all interest in the lease dated……20….., whereby the premises (here insert description of the property disclaimed) were demised to…… at a rent of Rs…… per annum (or per mensem) for a term of ……… years. Notice of this disclaimer has been given to……………………………………. Dated this….. day of…… 20…… Liquidator/ LLP Liquidator *The form to be suitably altered in the case of property other than lease.
Form No. 87G [See sub-rule (1) of rule 251] Investment Register Serial Number Name of the LLP Date of Investment Nature and particulars of security in which investment is made Amount invested Rate of interest etc. Date of realization of investment Remarks 1 2 3 4 5 6 7 8
Form No. 87H [See sub-rule (1) of rule 251] Register of book-debts and outstandings (Not barred by limitation) LLP Petition No…… of 20…… Name of LLP …………..(in Liquidation) LLPIN …………………………….. Serial Number Name and address of debtor Particulars of debt (Trade/ Bills/ Loans/ Advance etc.) Amount due 1 2 3 4 Instructions: Time barred debts may be considered for the purpose of realization in accordance with the Law.