Requester Information

Your First Name *

Your Last Name *

Your Email Address *

Building/Location *

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? *

Is the provider a former DMPS employee? *

Is the provider a current DMPS student? *

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 *

Provider Zip Code *

Provider Email Address

Fax Number

Phone Number

Has this provider provided services
to the district in the current year? *

Did the provider submit documentation?
Required Documents : Form W-9 and ACH Enrollment Form
*

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? *