Request for Invoice
State Collaborative on Assessment and Student Standards (SCASS)
DATE
SCASS Projects are based on a July 1 - June 30 fiscal year. This request will cover SCASS projects for the fiscal year beginning on July 1, 2005, and ending on June 30, 2006. For assistance, please see the back of this form or contact Carlise Greenfield at (202) 336-7066.
MEMBER FEE (VARIES BY PROJECT)
NAME OF SCASS PROJECT SURVEYS OF ENACTED CURRICULUM NAME OF ACCOUNT USED
Contact Information
$__________ ($20,000/ subj or 2 partic. )
PURCHASE ORDER NUMBER
STATE
PRIMARY CONTACT FOR ACCOUNTING OFFICE
NAME ADDRESS
PHONE E-MAIL
(
)
FAX
(
)
A
NAME
PROGRAM CONTACT: CONTENT OR ASSESSMENT PERSON
B
PROGRAM CONTACT: CONTENT OR ASSESSMENT PERSON NAME ADDRESS
ADDRESS
PHONE E-MAIL
(
)
FAX
(
)
PHONE E-MAIL
(
)
FAX
(
)
Billing Information
SPECIAL BILLING REQUESTS OR ARRANGEMENTS SPECIAL WORDING ON INVOICE Payment Schedule
DATE OF PAYMENT AMOUNT NOTES (In addition to the SCASS project name, number, contact person, fiscal year, and fee)
PERSON COMPLETING FORM AUTHORIZED SIGNATURE
_______________________________________________________________________________________ DATE
Please Print Name, Sign, and date
Send completed requests to:
CCSSO ACCOUNTS RECEIVABLE One Massachusetts Ave., NW Suite 700 Washington, DC 20001-1431 (202) 336-7006 Fax (202) 408-8072
Explanation of the Form for SCASS Project Payments
SCASS Projects are based on a July 1 - June 30 fiscal year. This request will cover SCASS projects for the fiscal year beginning on July 1, 2005, and ending on June 30, 2006.
Name of SCASS Project/Participation Fee/State
Use a descriptor such as "Health SCASS" or "SCASS/Arts Consortium;" fill in the amount of the yearly participation fee from the SCASS Projects Information Sheet; and indicate your state.
Name of State Account Used
This might be designated as "Assessment," "Standards Reform." or whatever funding source your state may use.
State Purchase Order Number
The State purchase order number assigned to this project.
Primary Accounting Office Contact Persons
This is the person who will receive the invoice and whose name will be listed on the invoice.
Program Contact Persons
This will usually be the names of the people who represent your state at the SCASS meetings.
Special Billing Arrangements
In some situations, the state's fiscal year or budget process may necessitate a delay in the payment, a splitting of payments, or other deviations from an immediate SCASS payment schedule. Provide an explanation here and indicate your intentions for a payment schedule.
Wording on Invoice
This is the information you would like to appear on the Invoice in addition to the SCASS Project Name, Contact Person, Fiscal Year, and Fee.
Payment Schedule
When payments need to be split, use this space to indicate the approximate dates and amounts planned in the payment schedule. This will allow CCSSO to anticipate payments appropriately.
Person Completing Form
This will usually be one of the persons listed in the state contact information above or a person designated by the supervisor.
Authorized Signature
Please print the name and provide the date of authorization. The form should be signed by the person with the authority to approve payment of the fee. This signature will authorize CCSSO to reimburse state representatives for any meetings before the state payment is received and provide assurance that the state will be a member of the project. For additional information or assistance, please contact: Council of Chief State School Officers One Massachusetts Ave., NW, Suite 700 Washington, DC 20001-1431