Adjudication Workshop Reimbursement

Instructors will be given an honorarium of $75 for each workshop instructed. Please complete after the final workshop you instruct.

Workshop Date(s)*
If you instructed multiple adjudicator training workshops, please use the plus sign to add a date for each one.
Check payable name*
Address*
Where to send reimbursement check

Street Address City State ZIP Code
Email*
Agreement*
As an independent contractor I understand Federal and State Income Taxes will not be withheld, and that I am responsible for any state and Federal revenue reporting.
- I agree
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