Special Services Agreement Request
Directions: To initiate a Special Services Agreement request, please fill this form out completely, accurately, and legibly AT LEAST one month prior to the date of service. Special Services Agreement Request forms that are submitted following the date of service will not be honored. The lack of any necessary information may cause prolonged processing.
The successful completion and submission of this form will result in:
- The generation of a Special Services Agreement on behalf of the Monroe Community College Association, Inc. with the Special Services Contractor that you designate
- The generation of a Funding Request Form
Once this form is processed, a special services agreement and a blank W-9 Request for Taxpayer Identification Number and Certification form will be sent (via the United States Postal Service) to the Special Services Contractor that you designate at the address that is listed on this form. The Special Services Contractor will have two weeks to return the signed special services agreement and the completed and signed W-9 Request for Taxpayer Identification Number and Certification form to the Monroe Community College Association, Inc. Failure to remit all necessary paperwork within the two-week time-span will result in the cancellation of the special services agreement and all of the terms therein. The Monroe Community College Association, Inc. will not be responsible for following-up with the Special Services Contractor should the reply to the special services agreement not be submitted in a timely manner. Once a special services agreement is cancelled, the submission of another Special Services Agreement Request form will be necessary to initiate a new special services agreement between the Monroe Community College Association, Inc. and the Special Services Contractor.
PAYMENTS WILL BE SENT TO THE SPECIAL SERVICES CONTRACTOR (via the United States Postal Service) AFTER THE DATE OF SERVICE PENDING SUCCESSFUL COMPLETION OF ALL TERMS OF THE SPECIAL SERVICES AGREEMENT