Ade Form 718 - Permanent Agreement Page 23
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23ARIZONA DEPARTMENT OF EDUCATION
Child Nutrition Programs
1535 West Jefferson Street
Phoenix, Arizona 85007
CHILD AND ADULT CARE FOOD PROGRAM
PERMANENT AGREEMENT
Revised May 2011
CFDA# 10.558
A.G. Contract No. KR02-1170-ALS
PERMANENT AGREEMENT
SIGNATURE PAGE
AGREED TO AND SIGNED:
1.
____________________________________
_____________________________________________
(Print or Type Name and Title)
(Signature of Designated Official)
[Same as item (6) on Certification Page, if applicable]
____________________________________
_____________________________________________
(Sponsor/School)
(Date)
Address _____________________________________________________________________________
OTHER AUTHORIZED SIGNATURES
2.
____________________________________
_____________________________________________
(Print or Type Name and Title)
(Signature)
3.
____________________________________
_____________________________________________
(Print or Type Name and Title)
(Signature)
4.
____________________________________
_____________________________________________
(Print or Type Name and Title)
(Signature)
FOR OFFICIAL USE ONLY
STATE BOARD OF EDUCATION
____________________________________________________________________________________
(Superintendent of Public Instruction or Designee)
(Date)
ADE FORM 718 (799)
23
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