subject_line
Requester Information
Your First Name
*
Your Last Name
*
Your Email Address
*
Building/Location
*
2100 Fleur
Blank
Brody
Brubaker
Callanan
Capitol Park
Capitol View
Carver
Cattell
Central Campus
Cowles
CPI
Dean Ave
DWP
Downtown
East
Edmunds
Findley
Focus
Garton
Goodrell
Greenwood
Hanawalt
Harding
Hiatt
Hillis
Home Instruction
Hoover
Howe
Hoyt
Hubbell
Jackson
Jefferson
JF Taylor
King
Lincoln
Lovejoy
Madison
McCombs
McKee
McKinley
Meredith
Merrill
Mitchell
Monroe
Moore
Morris
Moulton
North
Oak Park
Orchard Place
Park Avenue
Perkins
Phillips
Pleasant Hill
Prospect
River Woods
Roosevelt
Samuelson
Scavo
Smouse
South Union
St. Theresa
Stowe
Studebaker
Van Meter
Walnut Street
Weeks
Willard
Windsor
Woodlawn
Wright
Professional Services Agreement
This agreement is entered into the date listed below written between the Des Moines Public Schools (
District
) and (
Provider
):
Provider (Company) name:
Provider First name:
Provider Last name:
Is the provider a current DMPS employee?
*
Yes
No
Is the provider a former DMPS employee?
*
Yes
No
Is the provider a current DMPS student?
*
Yes
No
You state the provider is a current DMPS employee. Please carefully consider if this service creates a conflict of interest.
You state the provider is a current DMPS student. This is not the correct form. You will be directed to the Casual Labor form when you click the NEXT button.
How long has the former employee been separated from DMPS?
Please enter the date of separation.
*
Provider Street Address
*
Provider City
*
Provider State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Provider Zip Code
*
Provider Email Address
Fax Number
Phone Number
Has this provider provided services
to the district in the current year?
*
Yes
No
Did the provider submit documentation?
Required Documents : Form W-9 and ACH Enrollment Form
*
Yes
No
Upload Form W-9 submitted by provider
Upload ACH Enrollment Form submitted by provider
Here is a link to the documentation needed:
AP Forms
What account will be funding this agreement?
*