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.

Name of SCASS Project
SURVEYS OF ENACTED CURRICULUM / Member fee (varies by project)
$______
($20,000/ subj or 2 partic. ) / State
Name of Account Used / Purchase Order Number

Contact Information

PRIMARY CONTACT for Accounting Office
Name
Address
PHONE ( ) / FAX ( )
E-mail
A Program CONTACT: Content or Assessment Person / B Program CONTACT: Content or Assessment Person
Name / Name
Address / Address
PHONE ( ) / FAX ( ) / PHONE ( ) / FAX ( )
E-mail / E-mail

Billing Information

SPECIAL BILLING REQUESTS OR ARRANGEMENTS
SPECIAL WORDING ON INVOICE (In addition to the SCASS project name, number, contact person, fiscal year, and fee)

Payment Schedule

Date of Payment / Amount / Notes

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