zilongwang/ReadingBank huggingface dataset:
SCHOOL ORGANIZATIONS CLUBS The following clubs, activities, and organizations are available to all students: Academic Club Baseball Basketball (Boys & Girls) Best Friends Mentoring Cheerleading Chronicle Close Up Country (Boys & Girls) Dance Dic Dak (Yearbook) Drama Fast-Pitch Girls Softball FBLA/Midget Market FFA Football Golf (Boys & Girls) Gymnastics Hockey (Boys & Girls) Math Club Medical Explorers National Honor Society Pep Band SADD (Students Against Destructive Decisions) Science Club Skills USA Speech Student Council Student Congress Students for Service Swimming (Boys & Girls) Tennis (Boys & Track & Field (Boys & Girls) TSA (Technology Student Association) Volleyball Wrestling DICKINSON HIGH SCHOOL GRADUATION REQUIREMENTS English 4 credits Social Studies 3 credits Civics Test (North Dakota Century Code 15.1-21) Science 3 credits Mathematics 3 credits Physical Education 1 credit Life Skills ½ credit Required 14 ½ credits Electives 11 ½ credits
Description: A class for students completing their last year of instruction at Dickinson High School. Comprehensive instruction in the areas of post secondary education, occupational readiness, recreation and leisure activities, community access, and independent living options. Teacher recommendation. DICKINSON HIGH SCHOOL REGISTRATION GUIDE INDEX A Accounting I 31 Accounting II 31 Accounting III 31 ACT Testing 6 Active Chemistry 51 Administrators 2 Advanced Algebra I 44 Advanced Algebra II 45 Advanced American Govt (Dual Credit) 55 Advanced Art 29 Advanced Biology A 50 Advanced Biology B 50 Advanced Ceramics 30 Advanced Drafting & Design I 58 Advanced Drafting & Design II 59 Advanced Modern Nations (Dual Credit) 55 Advanced Photography 30 Advanced Physical Science A 50 Advanced Physical Science B 51 Advanced Placement Courses 8 Advanced Speech (Dual Credit) 41 Aerobics 49 Agriculture 27 Agriculture Processing (Meats) 27 Algebra I, Part 1, Algebra I, Part 2 44 Algebra II 45 Alternative Courses 62 American Government 53 American Literature 39 AP Biology (Dual Credit) 51 AP Calculus (Dual Credit) 46 AP Chemistry (Dual Credit) 52 AP Economics 54 AP Language & Composition 41 AP Literature 41 AP US History (Dual Credit) 55 Applied Animal Science 27 Applied Literature 41 Applied Psychology (Dual Credit) 56 Applied Topics in Daily Living 62 Applied Topics in English 62 Applied Topics in Math 62 Applied Topics in Occupational Educ 62 Applied Topics in School & Life Skills 62 Applied Topics in Science 63 Applied Topics in Social Studies 63 Art 28 Art History 30 Automotive Gen Service Technology I 59 Automotive Gen Service Technology II 59 B Banking & Finance 31 Basic Photography 29 Basic Psychology 54 Biology A 51 Biology B 51 Birds and Mammals 52 Botany & Horticulture Science 27 British Literature 39 Business Law 32 Business/Office/Marketing 31 C Ceramics 29 Chemistry 52 Child Development 34 Child Related Careers 34 Chorale 47 Civics Test 7,53 & Design 30 Communication Tech Student Aide 56 Communication Technology 57
Elite Division Only 98 106 113 120 126 132 138 145 152 160 170 182 195 220 285 Eligibility Birthday in the years 1996-2002 – 2015 High School Grads OK Match Length 3-3 FILA Rules Cost: Preregister $15.00 At the door $20.00 for preregistration go to Lake Erie AAU Wrestling Tab AAU CARD NUMBER____________________________________ NAME_______________________________________________ SCHOOL_____________________________________________ ADDRESS____________________________________________ PHONE____________________________ DOB____________ LAKE ERIE DISTRICT AAU FREESTYLE WRESTLING Elite Division CHAMPIONSHIPS Lake Erie AAU District Wrestling Championships Qualifier for 2015 Junior Olympic Games Virginia Beach, Virginia Columbiana High School 700 Columbiana-Waterford Rd. Columbiana OH 44408 Saturday May 23, 2015 Weigh Ins 7:30 – 9:30 AM Wrestling Starts at 10:00 AM Pre Registration at go to Lake Erie AAU Wrestling Tab Contact Dominic Mancini. AAU Lake Erie District Wrestling Chairman Information the Trip to Junior Olympics
School Information School Name: Address City, State, Zip School Phone # Mathematics Teacher(s) For recognition and future contact - even if not attending Name(s) email(s) # (s) Optional (Cell) # (s) Attending? Y / N Y / N Parent(s) (For Name Tags) Name(s) Optional (Cell) # (s) Contest Fees # of per person $ 2 Students (max 8) $11 Level 3 Students (max 8) $11 Sponsors (Teachers & Parents) $8 Total Fees: Make checks payable to: LRU Mathematics Contest Mail Payment to: Jessica Hannah Box 7213 University 625 7th Ave NE Hickory, NC 28601 Contact Information: Dr. Doug Burkholder, Math Contest 828-328-7257 Dr. Timothy Goldberg, Assistant Contest Chair: 828-328-7424 Jessica Hannah, Administrative Assistant: 828-328-7198 Driving Directions & Additional Information: Level 2 Registration Due April 1 Eligibility The Level 2 Contest is open to all students, including middle school students, who are enrolled or have been enrolled in Math 2 during the current academic year. A student enrolled in Math 2 last fall and Math 3 this spring may choose either contest. For students not on the common core, the teacher may decide the most appropriate contest. A student may compete in only one NC contest at only one test site each year. A student may compete only once in the Level 2 contest. If you have questions about eligibility consult:
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REGISTRATION FORM Safety and Chemical Engineering Education 2016 Faculty Workshop Chevron Energy Technology Company, Richmond, CA. Aug 21-24, 2016 Please complete this form, filling in the appropriate form fields return to Ronald J. Willey by June 15, 2016 Reservations are first come, first serve, 25 spaces are available Meals and room costs at the workshop are covered by SACHE Email to: Attendee Information First: MI: Last: Nickname for badge: University: Special Meal or Related Requests: Emergency Contact: Name: Phone: Your Contact Information Address: City: ST: Zip: Country: Cell Phone: Email: Hotel Information: Reservations will be made for you through this form: Hotel: Courtyard Richmond Berkeley 3150 Garrity Way Richmond, California 94806 IMPORTANT: Your room is reserved thru this form: Please check the nights that you need a room Satuday (8/20/16) ** Sunday Night (8/21/16) Monday Night (8/22/16) Tuesday (8/23/16) Wednesday Night (8/24/16) ** ** You will need to cover Sat & Wed nights if you need to stay early or late. Additional Information Needed: Citizenship? USA Chest Size for Nomex Suit? Length Reg, Long)? () Do you have Steel Toed Shoes? If No, Shoe size (USA measure)? Airline Information: This information can be added later…we will have a shuttle at SFO 3 PM 8/9 Arrival: Departure: Airline Airline Flight Number Flight Number Date Date Time Time any questions please contact ron Willey, 781-492-4956, or by email at r.willey@neu.edu
HOTEL RATING SINGLE BED DOUBLE BED TRIPLE BED HOTEL WEBSITE ACHAIA BEACH (Airotel) 4* 54€ [mount.view]/ 63€ [sea view] (low season)/ breakfast included 63€ [mount.view]/ 73€ [sea view] (low season)/ breakfast included 91€ {sea view}/ breakfast included PORTO RIO 4* 55€ / breakfast included 65€ /breakfast included 90€ / breakfast included ΤΖΑΚΙ 3* 40€ / breakfast included 50€ / breakfast included 60€ / breakfast included CASTELLO 3* 54€ / breakfast included 70€ / breakfast included 85€ / breakfast included KALLIRROE 3* 55€ / breakfast not included (American buffet breakfast 7€/person) 72€ / breakfast not included (American buffet breakfast 7€/person) TRANSPORTATION ATHENS – PATRAS – ATHENS
to cover the administration costs prior to your child starting at Little Nightingales Day Nursery. When a place has been confirmed in writing and a start date agreed a refundable fee of £150 is required to cover the settling-in sessions and of fees. This needs to be paid within 10 days of the confirmation letter. Your £150 deposit will be refunded once you have given us 1 calendar months’ notice of your child leaving the Nursery. Resignation notice must be given in writing. If you do not complete your settle in sessions and choose not take the space after registering, your deposit may not be refunded, however this decision is at the managers discretion. Once you have signed all the relevant documents, your place will be confirmed and you will be liable for payment of your fees in full from the original start date whether circumstances change or not. Fee are paid in advance. Fees are required on the first of each month, if we have not received payment by the seventh day there will be a charge of £35 payable. Where fees are not received by the last day of the preceding month we reserve the right to offer the place to another child. Fees are calculated on the number of weekly sessions attended, multiplied by 51 (weeks) and divided by 12 (months) to generate a fixed monthly charge. Please note: fees are payable during periods of absence from the Nursery including times of sickness, holidays and closures due to unforeseen circumstances. Little Nightingales have the right to impose an extra charge for late collection of children. This is calculated at £1.00 per minute and will need to be paid that day. The Nursery will be closed on all bank holidays. Fees will be charged as normal during any bank holiday closure. Little Nightingales wish to make it that it is our policy to close the nursery between Christmas Eve and New Year’s Day. This is subject to calendar change and is the reason why the fees are calculated over 51 weeks. We require one Full Calendar Months’ notice in writing regarding your resignation. Nursery Hours: Standard Day - 6.00pm Extended day: 7.30am - 6.30pm Morning session: 8.00am –1.00pm Afternoon session: 1.00pm – 6.00pm Children may arrive or leave earlier then the above times although full session fees will be charged.
Fill in those costs appropriate to your arrival and departure times. First time participants should arrive between from 6-7:00 p.m. on Friday evening. Classes will begin at 7:30 pm on the dot. If you are a returning participant you may arrive Friday evening, but your classes will not begin until 8:30 am on Saturday. Registration fee is $60.00, EXCEPT for RSO, is $40.00 and Hunter Ed if offered (free) (Everyone will be required to room Double, Triple, or Quad...NO SINGLES!) See Cancellation Policy Below NAME__________________________ COUNTY ___________________ I wish to room with: _________________________________ Please list/explain any allergies, dietary restrictions: ________________________________________________________________________________________ Registration is not complete until fees have been received. MAKE CHECKS PAYABLE TO: Kentucky 4-H Foundation. Write Shooting Sports WORKSHOP on the memo line. Cancellation Policy: For cancellations not made to the week of the workshop or for any no shows, the registration fees will not be refunded. Classes are scheduled on a first registered, first paid basis. *Don’t forget about the Silent Auction. Proceeds benefit Shooting Sports Camp*
Please return this form duly completed via fax or e-mail before 12 June 2016. Contacts: Ms. Qilin Wang FAX: +86-10-62045674 E-mail: wql@itsc.cn, Reservation Order Guest Name Position Company Contact Person Contact Number Email Arrival Date Departure Date No. of rooms Room Type Guaranteed By: □AX □VS □MS □DS □JCB □Others Credit Card Number： Card Holder： Expiry Date： Notes:
REGISTRATION INSTRUCTIONS: VIRTUAL ACADEMY Welcome to the Partnership! *Once we have verified Virtual Academy registration, either Rachel or our staff will issue the registration password to you. Send an email to to tell us you plan to register and need the password. *We don’t need any additional documents. *Create a family account at any time – access through the blue button on our website. It may be helpful to do this before registration opens. *Browse and decide on the classes you wish for each student through the CLASSES tab on our WEBSITE before registration That’s where you will find all the details you need to make your choices since only limited information will be available during registration. *During registration be sure to select the appropriate type of student: Virtual Academy: your students are already enrolled in BSPS Virtual Academy through Rachel Stout or you have met with her and have her approval to register with the program this semester. Students in this program are limited to 2 Partnership choices. *All students will have the same mentor teacher who will contact you the week before or the first week of school. Weekly student replies are a mandatory requirement of the program. See our website for more details.
Preferred Hotel Number of Rooms Type of Room Date of Arrival Date of Departure Number of Nights Board Basis Amount Total Please send this document, completed, to the Moroccan Judo Federation: openjuniorcasa2018@gmail.com DATE: Signature of the head of the delegation and stamp of the federation Form 3 : Travel Schedule and Transfers Federation Email Emergency Contact No Travel by Plane Date of Arrival Arrival Flight Number Arrival Flight Time Originating airport Arrival airport No of Persons
Date of Departure Departure Flight Number Departure Flight Time Departing from airport To airport No of Persons Please send this document, completed, to the Moroccan Judo Federation: openjuniorcasa2018@gmail.com DATE: Signature of the head of the delegation and stamp of the federation Form 4 : Visa Application Form FEDERATION:__________________Stamp Signature _________________ Our delegation needs the invitation from the__________ till the __________ of We will apply for visas at the Morocco Embassy _____________________________ (country, city) Please fill in the table in BLOCK LETTERS. Please also attach a COPY OF PASSPORT. Family Name Name Date of Birth Place of Birth Nationality Pass No Date of issue Date of expiry 1 2 3 4 5 6 7 8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Please send this document, completed, to the Moroccan Judo Federation: openjuniorcasa2018@gmail.com Form 5 : Rooming List Federation Emergency Contact No ARRIVAL DEPARTURE Family Name & Given Name Country Function/ W.Cat Hotel Type of Room (S/D) Arrival Flight Number Time Departure Time 1 2
M F S M L AS AM AL M F S M L AS AM AL M F S M L AS AM AL M F S M L AS AM AL M F S M L AS AM AL M F S M L AS AM AL M F S M L AS AM AL M F S M L AS AM AL M F S M L AS AM AL M F S M L AS AM AL Please use the following class abbreviations: LL – Little Lambs, EB – Eager Beavers, BB – Busy Bees, S – Sunbeams, B – Builders, HH – Helping Hands Non-staff parents, Siblings or Other Registration – Sabbath Only Circle your date: November 3 November 10 Name Gender Age (children) T-Shirt Size M F Y A S M L AS AM AL M F Y A S M L AS AM AL M F Y A S M L AS AM AL M F Y A S M L AS AM AL M F Y A S M L AS AM AL M F Y A S M L AS AM AL M F Y A S M L AS AM AL M F Y A S M L AS AM AL M F Y A S M L AS AM AL
Total number hoodies ordered: ______________ Total $$ enclosed: ________________ Comments/Special Needs Comments: Requests: Special Needs:
We want your child to feel as comfortable as possible on their first day of preschool. We suggest you introduce your child gradually by attending student orientation day. This is an opportunity for the students to attend preschool with their parents, meet the staff and fellow students, and see the classroom and things they will be doing. All children should wear comfortable clothes and shoes so they will be free to enter into play. Long dresses and smooth soled shoes and some sandals can be difficult to play in and may cause a fall. Girls wearing dresses are required to wear shorts underneath as to remain modest when on the playground or during circle time. Students are required to a backpack/tote bag and folder to preschool daily for transporting their papers, art, snacks and any other miscellaneous items. Please also include a change of clothes in a Ziploc bag with their name on it in case of an unexpected accident. We are prepared to serve only healthy children. We ask that you send your child to school only if he/she is not ill. (Please take a look at the guidelines for sickness on page 15) All children should come to school with a nutritional snack and drink for our snack time. Please make sure to bring to the teacher’s attention any allergies your child may have as special treats are served for birthdays and holidays. All children must be toilet trained before entering preschool. Please bring your child to the bathroom before entering class. Discipline We make every effort to have a discipline policy that practices positive reinforcement by praising good behavior and teaching self-control. If a child’s behavior indicates he may harm themselves or others or seems to be taking away from the educational opportunity of others, he/she will be temporarily removed from the immediate group. This will only be for a short time to help the child settle down and reflect on his/her behavior with the teacher’s guidance so they can rejoin the group. We believe discipline should be an opportunity to train the child in love. If a child has a continuing problem, the
PATIENT REGISTRATION PATIENT INFORMATION Name: (Last, MI) Address: City: Zip: Country: Mailing Address (if different from above): Home Phone: Work: Mobile: Email: SSN: Birth Date: Sex: M □ F □ Marital Status: Single □ Married □ Divorced □ Separated □ Widowed □ Unknown □ Race: □ Hispanic □ American □ Other Pacific Islander □ Other □ Asian □ Native Hawaiian □ American Indian □ Ethnicity: Hispanic/Latino □ Not Hispanic/Latino □ Other □ Language: Contact Preferred: Home □ Work □ Mobile □ Call for Appointment Reminder: Yes □ No □ Leave Message: Yes □ No □ Primary Care Physician: Referring Physician: EMPLOYER INFORMATION Employer Name: Phone Number: Address: City: State/Province: Zip: Country: EMERGENCY CONTACT INFORMATION Name: Relationship to Patient: Phone: Email:
Main Conference Attendee Information Last Name MI First Name Street Address Apt/Unit # City Zip Code Home Telephone # ( ) Alternate # ( ) Email Address TI Designation Club Name Club Number First Time Attendee? Yes No Current Office(s) Held 2nd Attendee – Household Member or Non-Toastmaster Guest Last Name MI First Name TI Designation (if applicable) Club Name & Number (if applicable): First Time Attendee? Yes No Current Office(s) Held (if applicable) Full Registration Includes three meals (Friday buffet dinner, Saturday lunch and banquet dinner; breakfast not included), educational sessions (for Toastmasters), and both contests. Per Attendee (until 5/1 / after 5/1): $80 / $100 Additional Attendees Each: $75 / $90 Qty Subtotal A La Carte Meals Only, Prices Per Person Qty Subtotal Friday Evening Buffet ($25 until 5/1; $30 after 5/1) Saturday ($20 until 5/1; $25 after 5/1) Saturday Dinner ($35 until 5/1; $40 after 5/1) A La Carte Educational Sessions & Contests Only Prices Per Person (No Meals) Saturday Educational Sessions ($15 until 5/1; $25 after 5/1) Friday Contest ($5 each) Saturday Contest ($5 each) Total Amount $ Meal Options Saturday Dinner: Circle one for each attendee. For special dietary needs, please email Attendee 1 Roasted Sirloin with Pinot Noir Reduction Chicken Breast with Sundried Tomato Cream Sauce Vegetarian Option Attendee 2 Sirloin (see description above) Chicken (see description above) Vegetarian Option Payment Information For the Conference: Make checks payable to “District 8 Toastmasters” and send with form by U.S. mail to: District 8 Toastmasters, 732 Goddard Ave, Chesterfield, MO 63005. For credit card payments, send this form to . An invoice will be emailed to you for payment. Payment covers conference costs. If you want to stay at the hotel, please make your arrangements and separate payment early. For Hotel Reservations: Call Renaissance St. Louis Airport Hotel at 800-468-3571 or fax 314-890-3102. Ask for the District 8 Toastmasters’ room rate of $85 per night (single/double occupancy) available until Monday May 6, 2013. Image credits: .
Affidavit Copy of rent / ownership Signature (Scan And Upload) The Building and Other Construction Workers Act Photo ID (For e.g., PAN Card, Driving License, Aadhar Card, Passport) Affidavit Address Proof of the Establishment Copy of rent / ownership Signature of Employer (Scan and Upload) The Inter-State Migrant Workmen Contractor Act (RE & CS) Certificate issued by the Principal Employer in Form V Affidavit Photo ID (For e.g., PAN Card, Driving License, Aadhar Card, Passport) Address Proof of the Establishment Copy of rent / ownership Signature of Employer (Scan and Upload) The Inter-State Migrant Workmen Principle Employer Act (RE & CS) Affidavit Photo ID (For e.g., PAN Card, Driving License, Aadhar Card, Passport) Address of the Establishment Copy of Rent / Ownership Signature (Scan And Upload) The Transport Worker Act Affidavit ID (For e.g., PAN Card, Driving License, Aadhar Card, Passport) Address Proof of the Establishment Copy of rent / ownership Signature (Scan And Upload) Registration of Establishments Employing Contract Labour Under The Contract Labour (Regulation And Abolition) Act, 1970
Registration Form Workshop Bayesian Clinical Trials Ulm University, Institute of Statistics and the IBS DR working groups „ Bayes Methodik“ and „Pharmazeutische Forschung“ Wednesday, 4 October 10:30 – 17:30 Thursday, 5 October 2017 09:00 – 17:00 at Ulm University Room Senatssaal Verwaltungsgebäude, Helmholtzstraße 16 I would like to attend the Workshop First name: Last name: Institution/Company (full address): Phone-No.: E-Mail: Vegetarian: Yes No „Einverständiserklärung“ Consent Form Please sign the attached document and send it back via email to Melanie Grimm. Please register by Friday 18 August 2017 via Email to Melanie Grimm: If you have administrative questions please contact Melanie Grimm (Boehringer Ingelheim), phone no.: +49 7351 54-4532. If you have functional questions please contact
Г-н Г-жа Д-р Доц. Проф. Име: (БГ) …………… (Латиница) ………………. Фамилия: (БГ)…………….. (Латиница)............................ Длъжност: ………………………….. Отдел........................................................................................... Организация/Фирма .............................................. Адрес:………………………………… Държава: …………………………… Тел.:…………………………. E-mail:…………………………. Дата на подаване:…………………
Columbus Children’s Healthcare Patient Name: Ha muerto alguno de los hermanos del nino/nina? □No □ Si Si contesto Si, explique: ALERGIAS: Incluyendo cual-Please list all of the allergies, including any allergic reactions to drugs: FAMILY HISTORY: Check any illnesses that the child or members of the child’s family have had: Child Family Child Family □ □ Frequent Ear Infections □ □ Diabetes □ □ Frequent Throats □ □ Kidney/Bladder Problems □ □ Croup □ □ Seizures/Convulsions □ □ Mumps, Measles, Chicken Pox □ □ Early Heart Disease □ □ Wheezing/Asthma □ □ High Cholesterol □ □ Pneumonia □ □ High Pressure □ □ Eye Problems □ □ Lung Disease/Tuberculosis □ □ Dental Problems □ □ Sexually Transmitted Disease □ □ Hearing Problems □ □ Alcohol/Drug use □ □ Hay Fever/Seasonal Allergies □ □ Cancer □ □ Emotional Disorders/Suicide Attempt □ □ Eczema/Skin Problems □ □ Anemia/Blood Problems □ □ Other Illnesses: DEVELEPMENT AND BEHAVIORAL ISSUES HEALTH AND SAFETY ISSUES Did the child sit alone by 7 months? Yes No Are there any guns in the child’s house? Yes No Did the child walk alone by 14 months? Yes No Does the child use a toothbrush daily? Yes No Did the child say 3 words by 15 months? Yes No Does the child use a car seat or seatbelt all of the time? Yes No Is the child doing well in school? Yes No Are there smoke detectors in the home? Yes No Does the child get along with other Is the hot water temperature less than children? Yes No 125°? Yes No Circle any of the following which the child has: Do you or someone in the household Nightmares/Sleep Problems Thumb Sucking know CPR? Yes No Irritable/Bad Temper Bed Wetting Toilet Training Problems Speech Issues Discipline Problems Breath Holding
ETHICS TEACHER TRAINING COURSE (ETTC) 22-25 2018 - Riyadh REGISTRATION FORM To be submitted to: cj.donabedian@unesco.org Deadline: 27 February 2018 1) PERSONAL INFORMATION Family Name (surname): __________________________________ First Name (given name): __________________________________ Gender: Male Female Date of birth (day/month/year): __/ __/ ____ Current nationality: ____________________________________ Permanent address: Street, number: ____________________________________ ZIP code: : __________ Country: ________ Mailing address (if different from permanent address): Street, number: _____________________________________ ZIP code: : ___________ Country: _________ E-mail address: __________________________________________ Telephone (include country code): _________________ 2) ACADEMIC INFORMATION English language skills: Native speaker Excellent Good Fair Speak Write Read Understand
NAME: COMPANY/INSTITUTION: REPRESENTING (If different) ADDRESS: CITY, ST, ZIP: EMAIL: YOUR GUEST (if applicable) GUEST EMAIL DIET RESTRICTIONS (FOR SELF & GUEST): VEGAN VEGETARIAN Gluten Free SHELL FISH OTHER IAB Event Registration 2/21/18 Includes breakfast, lunch, morning and afternoon breaks, joint Wednesday reception, dinner and all meeting materials. ACCE Event Registration 2/21 - 24/18 Includes continental breakfast, lunch, morning and afternoon breaks, joint Wednesday reception, & all meeting materials. I will attend the following: breakfast reception dinner I will attend the following: reception Thursday lunch Friday lunch Indicate # for all that apply Options Amount due extensions Indicate # for all that apply Options Amount due extensions Early registration @ $175 Before 12/20/17 $ Registration @ $395 $ Regular Registration @ $195 $ ACCE attendees joining 2/21/18 Wednesday IAB dinner only @ $75 $ Registration through a sponsorship @ $0/No Add'l. Cost Sponsor: Friday dinner for registered attended @ $35 $ Dinner guest @ $75 (List name above) $ Friday dinner for your guest @ $60 $ Spouse/Guest Tour @ $80 $ IAB Registrant Attending Thursday AM 2/22/18 Visiting Team Training with Free Lunch joining Thursday lunch @ $25 $ Guest joining Friday lunch @ $25 $ Sub Total Due for IAB events $ Sub Total Due for ACCE events $ PLEASE COMPLETE THIS FORM AND RETURN TO ACCE RIGHT AWAY, REGARDLESS OF YOUR PAYMENT OPTION. To submit completed forms, use one of the following: Payment Options: Total Due: $ Save and email to bhall @acce-hq.org Credit Cards or call ACCE – 210-495-6161 Fax to: 210-495-6168 Check to follow Mail to: ACCE, 825 W. Bitters Rd., STE 103 Send invoice San Antonio, TX, 78232 Questions or problems? Call ACCE at 210-495-6161
Review the details of your registration process. MEDI-CAL: Registration details appear in the body of the screen Information displayed includes: • The registration status reason • Fiscal Intermediary (FI)/Carrier/ Medicare Administrative Contractor (MAC) • Validation performed on registration PRINT THIS PAGE!!!!!!!!!!! MEDICARE: Registration details appear in the body of the screen. Information displayed includes: • The registration status reason • Fiscal Intermediary (FI)/Carrier/ Medicare Administrative Contractor (MAC) • Validation performed on registration. PRINT THIS PAGE!!!!!!!!!!! Have Questions? There are many resources available to you. Contact the EHR Information Center Help Desk for Questions concerning registration, (888) 734-6433 / TTY: (888) 734-6563 • Hours of operation: Monday-Friday 8:30 a.m. – 4:30 p.m. in all time zones (except on Federal holidays) • NPPES Help Desk for assistance. Visit; https://nppes.cms.hhs.gov/NPPES/Welcome.do (800) 465-3203 / TTY (800) 692-2326 • PECOS Help Desk for assistance. Visit; https://pecos.cms.hhs.gov/ (866)484-8049 / TTY (866)523-4759
Any gaps in care that could be better understood with a registry 1. 2. 3. 4. 5. Existing or future quality improvement efforts that could benefit from the data gathered by a registry 1. 2. 3. 4. 5. How the registry will fit into your existing workflows Consider a workflow map to guide your discussion. Responsibilities of your team members Administer training: Input information: Monitor: Report: Anticipated challenges to training, implementation and/or rollout of the registry 1. 2. 3. 4. 5. Metrics that could be reported to payors and/or partners and may enhance revenue through quality bonus programs 1. 2. 3.
Enter text detailing why you are seeking this amount in the Reason for Final Notice field. Click Next If you click Save, the data you have entered will be saved as a draft which you will be able to come back to at a later time and complete the process. The Manage Participants Page The Manage Participants screen allows you to identify all of the Senders and Recipients related to this Final Notice. When accessing this page a success message is displayed informing you the Amount information was saved successfully. You can also see in the Final Notice Summary section the amount entered during the Amount step is displayed. This summary section will continue to update as you provide additional information to provide an overview of the claim. All Final Notice’s must have at least one (1) Sender and at least (1) Recipient. As you create Senders and Recipients, their name and contact information will appear on the Manage Participants screen, you can then click on the name to edit the information or click the delete icon to remove the participant. Once you have finalised your Sender and Recipient information, Next to move onto the Summary workflow task. Senders and Recipients A Final Notice must include at least one (1) Sender and one (1) Recipient. The information you can record against senders and recipients are the same. Add a Sender To add a sender, click the Add Sender button. The Select which type of Sender you would like to create window will appear. Name: if you are the sender of this Final Notice select your name. Details will be retrieved from your profile to reduce the amount of data you need to provide Individual: if you are preparing on behalf of someone else. Organisation: if you are preparing on behalf of a registered company. Regular party: if you are preparing on behalf of a sender who is registered as a Regular Party. you have selected the type of Sender, click the Create button.
Contents Page Introduction and Methods Introduction 1 Content 1 Comparison with Previous Reports 1 Methods 2 Data Sources 2 Presentation of Data 3 Observed and Expected Case Counts 3 Standardized Incidence Ratios 3 Statistical Significance and Interpretation of SIRs 4 Example of Calculation of an SIR and Its Significance 5 Notes about Data Interpretation 5 Data Limitations 6 Border Areas and Neighboring States 6 Cases Diagnosed in Non-Hospital Settings 6 City/Town Misassignment 7 Small Numbers of Cases 7 Tables Observed and Expected Counts, with Standardized Incidence Ratios, by Sex, for 351 Cities and Towns, 2009 - 2013 9 Appendices Appendix I International Classification of Diseases for Oncology (Third Edition) Used for This Report 364 Appendix II Selected Resources for Information on Cancer 365 Appendix III Massachusetts Department of Public Health (MDPH) Cancer Prevention and Control Initiatives 366 REFERENCES 367
of Contents 0 Abbreviations and Definitions of Terms 0 Protocol Synopsis 0 1 0 2 0 3 0 4 0 5 REGISTRY/REPOSITORY ADMINISTRATION 0 6 DATA COLLECTION AND MANAGEMENT 0 7 SPECIMEN COLLECTION AND MANAGEMENT 0 8 PROVIDING RESULTS TO SUBJECTS 0 9 RISK ASSESSMENT/POTENTIAL BENEFIT OF PARTICIPATION 0 10 SAFETY MANAGEMENT 0 11 RECRUITMENT STRATEGY 0 12 CONSENT PROCESS 0 13 PUBLICATION 0 14 0 Appendix 0 BACKGROUND AND RATIONALE INVESTIGATIONAL PLAN STUDY PROCEDURES OF
1 (Can refer to the grant proposal.) Introduction Provide background and rationale for developing a registry/repository including information about the disease or condition, the target population and the unmet need and value of the desired information /specimen for future research. Potential future use of registry/repository Any cooperating investigators or groups that will utilize the registry/repository 1.2 Relevant Literature and Data Include literature and data that provide background for the study and established validity for scales and evaluation tools. STUDY OBJECTIVE Example: “The purpose of the registry/repository is to provide a mechanism to store, data, specimens, etc. to support the conduct of future research about…..” Primary Objective Secondary Objective (brief overview of registry/repository design ) Description Include a general description of the participating (if applicable), nature of the data and specimens and mechanisms for protection. Data/Specimen Collection Provide an overview of the methods that will be used for the data/specimen collection (database, interviews, physical examination, existing specimen sources, blood draws, biopsies, etc.) Study Duration, Enrollment and Number of Subjects Study Population -Inclusion and Exclusion Criteria
Promoting Entrepreneurship in Europe: Developing Solutions Towards Economic Growth and Job Creation 24th May 2016 Delegate Fees National Governmental Organisations, Executive Agencies, Legal Sector, Private Sector Local and Regional Authorities, Universities and Colleges, Trade Unions, Think Tanks 1 Place €395 / £345 per delegate €345 / £295 per delegate 2+ Places €345 / £295 per delegate €310 / £265 per delegate Delegate Details Delegate Name Position Address 1. 2. 3. Key Contact Details Invoice Details Name: Organisation: Department: Address: Telephone: Email: Invoice details are the same as Key Contact Details Name: Organisation: Department: Address: Telephone: Email: Purchase Order No. (if applicable): Method of Payment I will pay €/£ by credit card. Please contact me to obtain the necessary details Please invoice my organisation for €/£ I enclose a cheque for payable to Public Policy Exchange Ltd Confirmation I/We agree to notify you of all cancellations and changes in writing no less than 30 days prior to the date of the event. I/We further agree to pay €120/£100 administration charge per place on cancellation. If cancellation is received less than 30 days prior to the date of the conference then the full fee is payable; however, a substitute may be sent. Signed: Date: PLEASE EMAIL BACK TO
Type of Application Sponsor / Financial Support Amount (Incl. GST*) *GST is applicable for external payments Application for Research Project Full Industry Sponsorship $3,300.00* Application for Research Project Investigator initiated with industry funding 0.5% of total (funding) contract value up to $3,300.00* Application for Research Project Collaborative group sponsored or funded studies $165.00* (for external payments) $150.00 (for internal applicants - GST exempt) Application for Research Project via External Entity Agreement (EEA) N/A Refer to EEA for agreed fees Application for Investigator or Student Research Projects Investigator initiated or student project without an external funding source or competitive internal funding source $0 Appendix 2 – Naming Convention When uploading documents at the point of project registration, please DO NOT enter the version number and date. This information will have to be entered when completing the HREA, Q4.1 – Q4.2. Please use the following name convention for HREA, Q4.1 – Q4.2: Type of document (eg. Protocol) – version number – date (DD/MMM/YYYY) Examples: Protocol – version 2.3 – 01 May 2018 Patient information sheet and consent form – Master V2 – 15 Sep 2017 Please note that once a document has been uploaded into REGIS it is unable to be edited (even for minor administrative changes), therefore we recommend an
# Date Published In the Federal Register RIN Federal Register Citation/ Date Comment Period Ends Type of Rule Published/ Effective Date of Published Rule 42 9/29/2016 2900-AP57 Repayment by VA of Educational Loans for Certain Psychiatrists 81 FR N/A One Stage Final Rule/ 9/29/2016 41 9/23/2016 2900-AP78 Federal Civil Penalties Adjustment Act Amendments 81 FR 65551/ N/A Rule/ 9/23/2016 40 9/22/2016 2900-AP75 Authority to Solicit Gifts and Donations 81 FR 65286/ N/A Direct Final Rule; confirmation of effective date/ 9/9/2016 39 9/22/2016 2900-AP74 Authority of Solicit Gifts and Donations; Withdrawal 81 FR 65313/ N/A Withdrawal of Proposed Rule/ N/A 38 9/12/2016 2900-AP68 Telephone Enrollment in the VA Healthcare System 81 FR N/A Rule/ 9/12/2016 37 9/9/2016 2900-AP66 Diseases Associated with Exposure to Contaminants in the Water Supply at Camp Lejeune 81 FR 62419/ 10/11/2016 Proposed Rule/ N/A 36 8/29/2016 2900-AP77 Loan Guaranty: Delegation of Authority 81 FR 59137/ N/A One Stage Final Rule/ 8/29/2016 35 8/12/2016 2900-AP27 Schedule for Rating Disabilities; Skin Conditions 81 FR 53353/ 10/11/2016 Proposed Rule/ N/A 34 8/10/2016 2900-AP72 Veterans Employment Pay for Success Program 81 FR 52770/ 10/11/2016 Interim Final Rule/ 8/10/2016 33 8/5/2016 2900-AP73 Release of VA Records Relating to HIV 81 FR 51836/ 10/4/2016 Proposed Rule/ N/A 32 7/27/2016 2900-AP61 Supportive Services for Veteran Families Program 81 FR 9/26/2016 Proposed Rule/ N/A 31 7/20/2016 2900-AP51 Recognition of Tribal Organizations for Representation of VA Claimants 81 FR 47087/ 9/19/2016 Proposed Rule/ N/A
20 4/6/2016 2900-AP09 Health Care for Certain Children of Vietnam Veterans and Certain Korea Birth Defects and Spina Bifida 81 FR 19887/ N/A Final Rule/ 5/6/2016 19 4/4/2016 2900-AP05 Federal Agency Final Regulations Implementing Executive Order 13559: Fundamental Principles and Policymaking Criteria for Partnerships with Faith-Based and Other Neighborhood Organizations 81 FR 19355/ N/A Final Rule; Common Rule/ 5/4/2016 18 3/16/2016 2900-AP68 Telephone Enrollment in the VA Healthcare System 81 FR 13994/ 5/16/2016 Interim Final Rule/ 3/16/2016 17 3/2/2016 2900-AO95 Applicants for VA Memorialization Benefits 81 FR 10765/ N/A Final Rule/ 4/1/2016 16 3/2/2016 2900-AP21 Vet Centers 81 FR 10764/ N/A Final Rule/ 3/2/2016 15 3/1/2016 2900-AO92 Veterans Transportation Service 81 FR 10504/ N/A Final Rule/ 3/31/2016 14 2/8/2016 2900-AP42 Prescriptions in Alaska and U.S. Territories and Possessions 81 FR 6479/ 4/8/2016 Proposed Rule/ N/A 13 1/26/2016 2900-AP45 Fisher Houses and Temporary Lodging 81 FR 4223/ 3/28/2016 Proposed Rule/ N/A
4 11/5/2015 2900-AP11 Exempting Mental Health Peer Support Services from Copayments 80 FR 68447/ N/A Direct Final Rule; confirmation of effective date/ 1/27/2015 3 11/5/2015 2900-AP10 Exempting Mental Health Peer Support Services from Copayments 80 FR 68479/ N/A Withdrawal of Proposed Rule/ 11/5/2015 2 10/29/2015 2900-AP24 Expanded Access to Non-VA Care Through the Veterans Choice Program 80 FR N/A Final Rule/ 10/29/2015 1 10/20/2015 2900-AP37 Removing Net Worth Requirement From Health Care Enrollment 80 FR 63480/ 12/21/2015 Proposed Rule/ N/A
2010 U.S. Population Census (N=308,745,538) # of Diagnosed Cases in U.S. (SEER) (Prevalence) Estimated # of Diagnosed Cases in CLFM Population (Prevalence) Conditions Breast Cancer (F) N=87,502 2,899,726 1616 Breast Cancer (M) N=8,594 *ACS Est: (1 out 1,000) 9 Kidney Cancer N=127,874 358,603 149 Lymphoma Non-Hodgkins N=127,874 530,919 220 Esophageal Cancer N=127,874 34,551 14 Lung Cancer N=127,874 402,326 167 Bladder Cancer N=127,874 571,518 237 Leukemia N=127,874 302,800 125 Myeloma N=127,874 83,367 35 Neurobehavioral Effects 4.4% ADHD in population 145 Myelodysplastic Syndrome 11115 5 Scleroderma 741 0 Female Infertility 1,500,000 17 Hepatic Steatosis 30,000,000 1,243 Miscarriage 1,000,000 11 Toxicity 26,000,000 538 Subtotals: NA 4,530 * - American Cancer Society Estimates Furthermore, there is a substantial uncertainty as to when the number of CLFMs will submit and be found eligible for services under this law for the following reasons: the speculative data from USMC, whether or not one or more of the conditions is a direct result of toxins from CL, whether or not they are currently receiving affordable care/treatment and whether or not the CLFM is aware of the benefits offered by this law. Utilizing the maximum number of diagnosed cases in the CLFM population by prevalence, identified in Table 4, VA projected a range (10%, 25%, 50%, & 100%) of the potential diagnosed cases in the CLFM population (see Table 5) that may submit and be found eligible for services under this law.
episode of care is assumed to generate two visits to account for the initial visit and a follow-up visit (See Table 7). Table 7: Wait-Time Eligible- Estimated Number of Bills Eligible for Reimbursement of Third Party Cost Sharing – Updated March 2015 VA estimated its cost of reimbursing third party cost shares by applying a 3.7% CPI-U medical inflation rate to the FY 2013 average third party cost share of $78 per bill. The resulting $81 average third party cost share was applied to the estimated number of claims generated by this group of Veterans. VA was able to determine this amount because it collects patient responsibility or cost sharing amounts from electronic explanation of benefits (EEOBs) from those third-party payers from whom VA receives reimbursement for non-service-connected care. The reimbursement of costs shares would be between $1.4 million and $14 million (See Table 8.) Table 8: Wait-Time Eligible- Estimated Reimbursement of Third Party Cost Sharing- Updated March 2015 The total cost of care in FY2015 for the eligible Veterans on 30-day wait list and the EWL that may elect to receive non-VA care under VCP is estimated to be between $115 million and $1.151 billion. See Table 9. Table 9: Wait-Time Eligible- Base Year 2015 Total Cost of Care - 30-Day and EWL- Updated March 2015 Using a similar methodology as what was provided in the FY 2015 base year methodology, the estimated costs of FY 2016 and FY 2017 were estimated by decreasing the number of Veterans on the base year (FY2015) wait list by 25 percent in FY 2016 and by 50 percent in FY 2017. This assumption accounts for the anticipated reduction in the wait list, as VA increases its internal capacity to deliver care at a VA medical facility through additional hiring, together with the acquisition of the accompanying space through leasing or construction. A projected annual CPI-U medical inflation rate of 3.8% in FY 2016 and 3.9% in FY 2017 was applied to all out year
Summary of Estimated Program Costs/Savings Due to the uncertainties regarding the rate of potentially new enrollees in the Veteran Choice Program and on the best reasonably obtainable data, VA has prepared Low and High End Volume estimates for determining the costs of this rulemaking. Based upon the assumptions that authority to spend funds under this current legislation expires no later than August 7, 2017, the Low End Volume total costs associated with this rulemaking are estimated to be $315 million and the High End Volume total costs are estimated to be $1.8 billion. Low End Volume Estimate Fiscal Year Removing Requirement for Enrollment Prior to August 1, 2014 Calculating Driving Distance Only to Sites with Full Time Primary Care Physician Excessive Burden Total Costs to VA 2016 $21,000,000 $64,000,000 $53,000,000 $138,000,000 FY 2017 (through Aug 7) $20,000,000 $48,000,000 $109,000,000 $177,000,000 $41,000,000 $112,000,000 $162,000,000 $315,000,000 *Numbers may not add up due to rounding. High End Volume Estimate Fiscal Year Removing Requirement for Enrollment Prior to August 1, 2014 Calculating Driving Distance Only to with Full Time Primary Care Physician Excessive Burden Total Costs to VA 2016 $92,000,000 $284,000,000 $158,000,000 $534,000,000 FY 2017 (through Aug 7) $154,000,000 $372,000,000 $760,000,000 $1,286,000,000 Total $246,000,000 $656,000,000 $918,000,000 $1,820,000,000 *Numbers may not add up due to rounding.
Appendix A: Maximum permitted post-origination fees Fee VA Residential Credit Solutions (RCS) Bank of America (BoA) Wells Fargo Ocwen Fee $350 $350 Not disclosed $95-250 $200 Assumption Fee $300 $350 Not disclosed Not disclosed $1300 Partial Release Fee $350 $350 NA NA $500 Payment by Phone Fee $10 $9-12 $15-20 $0-20 $12-19.50 Payment with a $12 $9-12 $15-20 $0-20 $12-19.50 Release of Lien Fee $15 $15 Not disclosed ($100 when pay off/refinance loan) Not disclosed Varies by Payoff Statement Fee $30 Not disclosed $30 (expedited) $5-10 $30 (Attachment 2) Department of Memorandum Veterans Affairs Date: August 9, 2016 From: Acting Financial Officer (24) Subj: AP32(P) - Vendee Loan User Fees and Servicing Expenses To: Director, Loan Guaranty Service (26) 1. The Office of Resource Management (ORM) reviewed a description of the rulemaking for new vendee loan user fees from the “Impact Analysis for RIN narrative. The rulemaking prescribes the regulatory authority under which the Secretary of the Department of Veterans Affairs (VA) collects reasonable user fees in connection with the origination and servicing of vendee loans. The proposed loan fees
prescriptions, review must be at least annually. Illinois Meetings Must generally “provide collaboration and consultation” and also to meet the requirement to “discuss the condition” of any patients prescribed controlled substances Monthly 225 Ill. Comp. Stat. Ann. & 68 Ill. Adm. Code 1300.420 Illinois Chart review “Medication orders shall be reviewed periodically by the collaborating physician or podiatric physician.” Periodically 225 Ill. Comp. Stat. Ann. Indiana Chart Review 848 IN ADC 5-1-1 Mississippi Chart Review Collaborating physician must review 10% of an NP’s charts, or 20 individual charts, whichever is Monthly Miss. Code 30-18-2840:2.3 Missouri Chart Review Collaborating physician must review a minimum of 20% of all charts, and a minimum of 10% of all charts for patients who were prescribed controlled substances. The 10% of controlled substance charts may count toward the 20% of all charts. Every 14 days MO ST 334.104 Missouri On-Site Time With exception for providers of population-based public health services (as defined), collaborating physicians must be on-site for a minimum of one month at beginning of collaborative agreement relationship One-month at onset of collaborative relationship MO ST 334.104 North Carolina Meetings Scheduled meetings At least once monthly during the first six months of a collaborative agreement relationship, and at least every six months thereafter 21 NCAC 36.0810 Ohio Meetings A “conference” must be held following chart review OH ST
Vocational Rehabilitation and Employment Service (VR&E) Regulations Identified for Revision or Clarification Implementation of Public Law 111-377 21.260 Subsistence Allowance 21.264 Election of payment 21.270 Interval Pay Updates related to Public Law 110-181, including 21.40 Entitlement 21.260 Subsistence Allowance 21.282 Effective Date of Induction / Retroactive induction 21.76 Independent Living 21.160 Independent Living Services Entrance / Re-entrance into a program of Rehabilitation 21.284 Re-entrance into a program of rehabilitation 21.198 “Discontinued” status 21.196 “Rehabilitated” status “Limited” Employment Services per Circular 28-97-1 (38 USC 3117) 21.47 Eligibility for Employment Assistance 21.40 Basic Entitlement Beneficiary Travel 21.370 Intraregional Travel at government expense 21.372 Interregional Travel at government expense 21.376 Travel expenses for initial evaluation and counseling
NAME: _ ___________ ___________ D.O.B.: ___________________________ CURRENT CLUB: ______________________ 2015 REG. No. ______________________ PREVIOUS CLUB/S: _ _____________________________________________________________________ CONTACT DETAILS: Phone No.___________________ Email: _________________________________ Please fill in your finishing position in the following events CROSS COUNTRY CHAMPIONSHIPS Novice Result Intermediate Result Inter Inter Club Result Year Ind Placing Team Placing Ind Placing Team Placing Ind Placing Team Placing Ind Placing Team Placing 2007 2008 2009 2010 ROAD CHAMPIONSHIPS Year 10k Result Half Result Result Ind Placing Team Placing Ind Placing Team Placing Ind Placing Team Placing 2007 2008 2009 2010 TRACK & FIELD CHAMPIONSHIPS YEAR 2007 2008 2009 2010 Championship Place Time Time Place Time Place Time