Distrito Escolar del - Osceola County School District

TITLE I SUPPLEMENTAL EDUCATIONAL SERVICES CONTRACT
Each party signing this contract on behalf of either party individually warrants that he or she has full legal power to execute the contract on behalf of
the party for whom he or she is signing and to bind and obligate such party with respect to all provisions contained in the contract.
THE SCHOOL BOARD OF OSCEOLA COUNTY, FLORIDA:
By: ____________________________
Barbara Horn, Chairman
Date Approved: ___________________
ATTEST:
By: ____________________________
Melba Luciano, Superintendent
The School Board of Osceola County, Florida
817 Bill Beck Blvd.
Kissimmee, Florida 34744
SUPPLEMENTAL EDUCATIONAL SERVICES PROVIDER:
____________________________________________________________________________
Provider Authorized Representative: Name / Title / Signature / Date
____________________________________________________________________________
Name of Supplemental Educational Services Provider:
____________________________________________________________________________
Address
____________________________________________________________________________
City / State / Zip Code
____________________________________________________________________________
Phone Number/ Tax Identification Number:
____________________________________________________________________________
Fax Number
____________________________________________________________________________
Email Address
Authorized name, contact number and address for sending notice and information if different from above:
____________________________________________________________________________
Name / Title
Address
____________________________________________________________________________
Date / Phone number
City / State / Zip Code
____________________________________________________________________________
Fax Number
____________________________________________________________________________
Email Address
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