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Metropolitan Life Insurance Company Group Number: 94072 To Be Completed by Employee (You must review the important statements on page 2 and sign where indicated before completing this section of the form.) 1. Patient First Name Middle Last 2. Relationship to Employee 3. Sex 4. Married? 5. Patient Date of Birth 6. Report Number Mo. / Day / Year Ⅺ Self Ⅺ Spouse Ⅺ Child Ⅺ Male Ⅺ Yes Ⅺ Other Ⅺ Female Ⅺ No 7. If Full Time Student (Age 19 or Over) School City 8. EMPLOYEE Social Security / ID Number State 9. If Disabled (Age 19 or Over) 94075 10. Name of Group Dental Program MTA Consolidated Managerial Plan Ⅺ Yes Ⅺ No 11. Employee First Name Middle Last 14. Employee Residence Mailing Address 15. City, State, Zip Ⅺ Yes Ⅺ No 16. Are other Family Members Employed? 13. Office Phone (Area Code) 12. Employee Date of Birth Name 17. Date of Birth 18. Name and Address of Employer for Item 16 Social Security / ID Number. 19. Is Patient Covered by Another Dental Plan? Dental Plan Name Ⅺ Yes Ⅺ No (If Yes, complete the following:) Name and Address of Carrier Group No. 20. I Authorize Release of any Information Relating to this Claim 21. I Certify that the Above Information is Correct. 22. I Authorize Payment Directly to the Below Named Dentist. ____________________________________ Employee Signature _______________________________________ (Signature of Patient or Signature of Authorized Representative if Minor) __________________________________ Employee Signature _______________ Date If Authorized Representative, Relationship to Minor __________________ Date __________________ Date To Be Completed by Dentist 23. Dentist Name 24. Mailing Address 25. Dentist Social Security Number or T.I.N. 28. First Visit Date Current Series City State Zip 27. Dentist Phone Number 26. Dentist License Number 29. Place of Treatment 30. Radiographs or Models Enclosed? Ⅺ Office Ⅺ Hospital Ⅺ ECF Ⅺ Other _______________________________________ Ⅺ Yes Ⅺ No How Many?_____________ 31. Is Treatment Result of Occupational Illness or Injury? (If Yes, Enter Brief Description and Dates) Ⅺ Yes Ⅺ No 33. Other Accident? Ⅺ Yes Ⅺ No (If Yes, Enter Brief Description and Dates) 35. If Prosthesis, is this Initial Placement? 37. Is Treatment for Orthodontics?
FEATURES: Attractive 3 and 4 Bedroom Homes Beautiful Decorative Door Attractive Lighting w /Ceiling Fans Family Room Nook Dining Room Master Bedroom w/ walk in closets Two/Three Additional Bedrooms Master Bath & Full Bathroom Spacious Energy Efficient Kitchen w/ Granite Countertops Refrigerator w/ Ice Maker Dishwasher Flat Top Range Washer/Dryer Ceramic Tile Floors Wood Laminate Floors Central Heat & Air Pre-Wired for Cable Activated Security System Irrigation System Covered LanaiLarge Backyard 4230-4250 HARBOR VIEW PLACE For Sale! Asking Prices are in the Lower $100.000’s CALL TODAY! OUR HOUSING COUNSELOR WILL GUIDE YOU THROUGH THE PROGRAM AND PREPARE YOU FOR THE RESPONSIBILITY OF HOMEOWNERSHIP. 904-358-1224 *Subsidy amount may vary ** For more information visit our website 3105 N. Main Street Jacksonville, FL 32206 Office: 904-358-1224 Get A $250 Visa Card for every home buyer you refer that closes w/ Metro North CDC www.MetroNorthCDC.com Metro North’s Harbor View Place You May Receive Up To $40,000 In Down Payment Assistance* FEATURES: Attractive 3 and 4 Bedroom Homes Beautiful Decorative Door Attractive Lighting w /Ceiling Fans Family Room Nook Dining Room Master Bedroom w/ walk in closets Two/Three Additional Bedrooms Master Bath & Full Bathroom Spacious Energy Efficient Kitchen w/ Granite Countertops Refrigerator w/ Ice Maker Dishwasher Flat Top Range Washer/Dryer Ceramic Tile Floors Wood Laminate Floors Central Heat & Air Pre-Wired for Cable Activated Security System Irrigation System Covered LanaiLarge Backyard 4230-4250 HARBOR VIEW PLACE For Sale! Asking Prices are in the Lower $100.000’s CALL TODAY! OUR HOUSING COUNSELOR WILL GUIDE YOU THROUGH THE PROGRAM AND PREPARE YOU FOR THE RESPONSIBILITY OF HOMEOWNERSHIP. 904-358-1224 *Subsidy amount may vary ** For more information visit our website Get A $250 Visa Card for every home buyer you refer that closes w/ Metro North CDC 3105 N. Main Street Jacksonville, FL 32206 Office: 904-358-1224 www.MetroNorthCDC.com
The Welcome Center located in the Gymnastics Center lobby is staffed all day during the week and in the mornings during program times on the weekends. All class, camp and team monthly, meet & summer fees should be paid here! We also sell Gymnastics Sweatshirts, t-shirts, leotards, shorts and bags at the desk. Snacks and drinks are also for sale. SUMMER TEAM REGISTRATION HAS STARTED! Registration is due on or before Friday, May 23rd. Payment in full is due with your form. Level 4 gymnasts- please note: all weeks are available for you to choose this summer. Regardless of which weeks you choose you will follow the schedule set for level 4. If you need an extra form please see the Welcome Center. Registration forms and payments should be returned to the Welcome Center. ALL CHECKS PAYABLE TO YMCA OF METRO NORTH Effective immediately checks used for payments of any kind at the Gymnastics Center should be made payable to “YMCA of Metro North”. WEBSITE The team will be using the YMCA of Metro North website. Please remove the old link and add this one to your favorites! The site address is: http://ymcametronorth.org/locations/gymnastics/team/ You can also Find Us On Facebook (YMCA of Metro North Gymnastics Center) and Follow Us On Twitter (GymnasticsY). EXTRA GYM TIME Did you know we now offer Open Gym time for anyone looking for extra practice? You do not need to pre-register to attend. Drop-In Rates are: Family Member: $10/class Youth Member: $15/class Non-Member: $20/class Open Gym Schedule through Sunday, June 22nd Friday 3:00-4:00pm (5-18 years) Sunday 11:15am-12:15pm (5-18 years) Sunday 1:00-2:00pm (5-18 years) Tumble Drop-in* Saturday 1:00-2:00pm (11-18 years) *Floor and set stations only
Model MD711, MD712 Apple believes that improving the environmental performance of our business starts with our products. The careful environmental management of our products throughout their life cycles includes controlling the quantity and types of materials used in their manufacture, improving their energy eﬃciency, and designing them for better recyclability. The information below details the environmental performance of the 11-inch MacBook Air as it relates to climate change, energy eﬃciency, material eﬃciency, and restricted substances.1 Date introduced June 10, 2013 Climate Change Greenhouse gas emissions have an impact on the planet’s balance of land, ocean, and air temperatures. Most of Apple’s corporate greenhouse gas emissions come from the production, transport, use, and recycling of its products. Apple seeks to minimize greenhouse gas emissions by setting stringent design-related goals for material and energy eﬃciency. The chart below provides the estimated greenhouse gas emissions for the 11-inch MacBook Air over its life cycle. Greenhouse Gas Emissions for 11-inch MacBook Air Recycling, 1% Transport, 5% The 11-inch MacBook Air is designed with the following features to reduce environmental impact: Production, 75% Customer use, 19% • Arsenic-free display glass • Mercury-free LED-backlit display • Brominated flame retardant–free Total greenhouse gas emissions: 320 kg CO2e • PVC-free2 • Recyclable aluminum enclosure Meets ENERGY STAR® Version 5.2 requirements Achieves a Gold rating from EPEAT3 Energy Eﬃciency Because one of the largest portions of product-related greenhouse gas emissions results from actual use, energy efficiency is a key part of each product’s design. Apple products use powerefficient components, and software that intelligently powers them down during periods of inactivity. The result is that MacBook Air is energy efficient right out of the box. The 11-inch MacBook Air outperforms the stringent requirements of the ENERGY STAR Program Requirements for Computers Version 5.2. Using only 5.9W in idle with the display on, it consumes less power than any Mac, and consumes 49 percent less energy than the original MacBook Air. The following table details power consumed in diﬀerent use modes. Power Consumption for 11-inch MacBook Air Mode
OFFERING AT DISCOUNTED RATE TO STUDENTS AND FACULTY – REG REF: Letter No. DLIPL/029/13-14 dated: 31/07/2013 received from M/s. Datalogics India Pvt.Ltd., Chennai, authorized dealer of M/s.Apple. ***** M/s. Datalogics India Pvt.Ltd., Chennai has sent one letter informing about the Back to School Promotion offer. The details of the scheme are: 1. The name of the programme is “ Apple Back to School Program” 2. The program will run up to 15/09/2013 for Apple Desktop and Laptop and up to 28.09.2013 for Apple iPad. 3. The scheme is applicable for the students as well as for the faculty. 4. The offered promotional rate after reduction of rebate and inclusive of VAT is available with the Stores and purchase Section. The faculty and the students have to produce the documents as required by them. The details will also be loaded in the ice website under the head documents of Stores and purchase Section shortly. 5. The company has to supply the items by billing in the name of students and faculties only and the payment will be made by them directly in the form of cash/individual cheque/credit card. 6. The Faculty has to produce copy of any one of the documents such as photo copy of I.D.Card, Driving Licence, Passport, Voters ID, and PAN Card etc. The students have to produce student ID card/last semester marksheeet/ Bonafide Certificate/Fee receipt. Fresh students have to submit admission letter and fee receipt 7. The order has to be placed with M/s. Datalogics India Pvt.Ltd., Chennai. 600 018. Contact person Sri Suresh Mobile no; 9445864203 8. Warranty: One year international Warranty.
MLTI Apple Program Description Goals The MLTI goals remain: • Equity • Integration with Maine’s Learning Results • Sustainability / Avoiding Obsolescence • Teacher Preparation and Professional Development • Economic Development At a school and classroom level, these goals can be translated into a few more tangible actionable goals: 1) changing teacher practices in ways that leverage technology to facilitate a student-centered learning environment, and 2) active participation in on-going professional development efforts. Professional Development Apple Professional Development (APD) brings educational experience and curriculum knowledge to every workshop delivered. With over 10 years of collaborative work in Maine, the APD team is comprised of trained educators with years of classroom and leadership experience. APD delivers comprehensive professional development programs focused on supporting classroom teachers along with building and district leaders. The comprehensive Professional Development plan outlined in this solution focuses on teaching and learning best practices underpinned by a long-term association with the SAMR Model, learned from the work done with MLTI. An emphasis on hands-on, engaging learning is foundational to the offerings outlined from Apple Professional Development. Whether through the use of online resources from iTunes U, face-to-face engagement in a traditional workshop setting, classroom coaching and mentoring, or as part of the Leadership Cadres, Apple’s comprehensive Professional Development plan is ready to take Maine educators to new levels of capability and effectiveness.
1888 Press Release - On average, SBGA Payroll Services saves members over $1,900 annually when compared to big name competitors. When you add in the free direct deposit for all employees, free federal and state compliance posters for the workplace, and ability to run payroll as many times as you need a month for one flat fee, the savings grow exponentially.
The Michigan Competitive Scholarship program is available to undergraduate students pursuing their first degree at an approved Michigan postsecondary institution. Students must demonstrate both financial need and merit and eligible applicants must achieve a qualifying ACT score prior to entering college. Application Applicants must file the Free Application for Federal Student Aid (FAFSA). Students whose FAFSA is received by March 1 will receive priority consideration. Students are encouraged to file their FAFSA on the Web at www.fafsa.gov. Paper forms are available from the Federal Student Aid Information Center by calling 1-800-4FED-AID or a printable version can be accessed on the www.federalstudentaid.ed.gov Web site. The FAFSA allows students to list multiple colleges when filing. Because Student Scholarships and Grants (SSG) does not know which college the student will select, the award is based on the first college listed. Students must file a renewal FAFSA every year to determine possible continued program eligibility. The student is responsible for notifying SSG of a change of address or college choice. Program Limits Awards are restricted to tuition and mandatory fees. Awards may pay a maximum of $630 per academic year at a Michigan public college or university or $1,524 per academic year at a Michigan independent college or university1. Program eligibility ends when a student has received a baccalaureate degree, after completing the equivalent of ten (10) semesters or 15 terms, or when a student has been out of high school over ten years, whichever occurs first. Future awards are subject to available and approved funding.
Buick and the GM Foundation would like to Congratulate the 2013 Recipients of the. Buick Achievers Scholarship Program. 100 National Buick Achievers. Buick and the GM Foundation would like to Congratulate the 2013 Recipients of the Buick Achievers Scholarship Program 100 National Buick Achievers Up to $25,000 in annual scholarship funding 1000 Buick Achievers $2,000 in scholarship funding 2013 National Buick Achievers Up to $25,000 in scholarship funding Yasimen Aboubaker Kristine Bartz Amanda Baxter Shakopee, MN Oxford, MI Lewistown, PA New York University Kettering University California University of Pennsylvania David Beahr Amanda Bjorkland Thomas Blandford Windber, PA Daytona Beach, FL Waldorf, MD West Virginia University Embry-Riddle Aeronautical University Virginia Polytechnic Institute and State University Amber Bryan Phong Bui Donald Chao Memphis, TN Columbus, OH Bellevue, WA University of Notre Dame Ohio State University: Columbus Campus University of Michigan Kevin Chon Lydia Chou Brandon Clifford Cerritos, CA Diamond Bar, CA Virginia Beach, VA Carnegie Mellon University University of California: San Diego University of Virginia Ryanne Dailey Rosario Diaz Shade Douglas Carthage, ME Houston, TX Amherst, NY Worcester Polytechnic Institute University of Houston Spelman College Nartezya Dykes Madhu Elias Paulo Fonseca Franklinton, LA Orlando, FL Fontana, CA Spelman College Cornell University University of California: Berkeley James Gaddy Natalia Gonzalez Kyriunna Harris Peru, IN Coppell, TX Memphis, TN Purdue University Boston College Kettering University Lindsey Hutchinson Tory Jim Jordan Johnson Wylie, TX Pocatello, ID Columbia, MD Oklahoma State University University of Nevada: Reno Hampton University Nicole Kennard Kelsey Kilburn Rebecca Klem Acworth, GA Lawrence, KS
The National Center for Learning Disabilities is seeking applicants for the 2013-2014 Anne Ford Scholarship. The Anne Ford Scholarship is a $10,000 ($2,500/year over four years) award granted to a graduating high school senior with a documented learning disability who will be enrolled, in the fall of 2014, in a full-time bachelor’s degree program. The ideal Anne Ford Scholar is a student who:• Articulates his/her LD and clearly demonstrates the importance of self-advocacy • Is committed to completing a four-year college degree and has begun to set realistic career goals • Participates in school and community activities • Has demonstrated academic achievements consistent with college and career goals • Plans to contribute to society in ways that increase opportunities for individuals with LD • Excels as a role model and spokesperson for others who struggle with LD • Demonstrates financial need Eligibility & Selection Criteria To be eligible for the 2013-2014 Anne Ford Scholarship, an applicant must:...