EXHIBIT C

SERVICES & PAYMENT REQUEST FORM (“SPRF”)

SaturdayAcademy (“SA”) will collaborate with School District No. 1J, Multnomah County, Oregon, (“PortlandPublic Schools” or “District” or “School”)to provide classes for curious and motivated 1st-12th grade students at District Schools under the following terms:

1.SA Class or Workshop Name:

2.Class or Workshop Date(s), Time(s), and Location(s):

Time-saver: You may schedule more than one SA class without completing a new SPRF.

3.School Name; Contact Name, Telephone, Email:

4.SA Contact Name, Telephone, Email: Heidi Venneri, School-Based Program Coordinator, 503.200.5859,

5.Teaching Space: The School shall provide space suitable for teaching the class(es), including tables, desks, chairs, chalk/white boards, etc. SA and the School should resolve these needs before the program date.

6.Validity: This SPRF shall be considered valid and binding when executed by the authorized representatives from SA and the School.

7.Invoices; Payment: SA shall submit its invoice to the School representative listed in Section 3, above. The School representative MUST NOT WRITE A CHECK to SA. Instead, District Accounting Services will pay SA on behalf of the School net 30 days. See Exhibit B (Directions and Processing: Services & Payment Request Form) for help.

8.Master Contract: This SPRF shall be subject to the terms and conditions of the Master Contract (MSTR 56675, “Contract”) entered into between the parties and any subsequent amendments to the Contract. This SPRFmay include other terms, conditions, modifications, or deletions to which the parties agree. In all cases of conflict between this Form and the Contract, the Contract shall take precedence over this SPRF’s language.

SCHOOL DISTRICT NO. 1JSATURDAY ACADEMY

MULTNOMAH COUNTY, OREGON

Signature of School Principal for the Heidi Venneri,

Chartfield BelowSchool-Based Program Coordinator

Printed Name of School PrincipalDate

Date

SCHOOL PRINCIPAL:

Your signature above authorizes the Services described in this SPRF and payment for those Services from the chartfield below. Please complete the chartfield.

If you want Accounting Services to bill a third party for the class(es), please write “TO BE PAID FOR BY ______” (or similar words that clearly name the paying party) in the chartfield below.

ACCOUNT / FUND / DEPT. / PROGRAM / CLASS / GRANT / AMOUNT
TOTAL AMOUNT

APPROVED BY GRANT ACCOUNTING

(Required only if grant funds are used):

Signature or stamp of Grant Accountant / Date

Saturday Academy-PPS, MSTR 56675

Exhibit C (“SPRF”), Page 1 of 2

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