Special Services Agreement Request

To initiate a Special Services Agreement request, please fill this form out completely and accurately 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 Special Services Agreement Request form also includes the Special Services Agreement on behalf of the Monroe Community College Association, Inc. with the Special Services Contractor that you designate. A Funding Request Form will also be generated.

As part of the agreement form, a completed W-9 Request for Taxpayer Identification Number and Certification form from the Special Services Contractor will need to be uploaded. 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 canceled, the submission of another Special Services Agreement form will be necessary to initiate a new special services agreement between the Monroe Community College Association, Inc. and the Special Services Contractor.

Complete the Special Services Agreement Form