HELP ME GROW COLLABORATIVE FAMILY SUPPORT SERVICE AGREEMENT
This agreement is between _________________________, and the Help Me Grow Collaborative (HMGC). I agree as follows: • The term of the agreement shall be from July 1, 2005 through June 30, 2006 • Families who are members of the HMGC will receive an honorarium of $20.00 per meeting for attendance at HMGC meetings or activities. • To receive reimbursement the family involvement and service agreement forms must be submitted to the HMGC Family Support Manager. Honoraria are contingent on the availability of funds.
Signed this _____ day of ________________.
Signature Date of Birth Social Security #
____________________ ____________________ ____________________ ____________________ ____________________
___________________________________________ Melissa Manos, HMGC Director Angela K.Lowder, Director, Finance and Data Systems ___________________________________________ Cheryl Selak, HMGC Family Support Manager
Help Me Grow Collaborative 2421 Community College Avenue Cleveland, Ohio 44115 Phone (216) 736-4300 Fax (216) 592-4920