New Hampshire Humanities completes this section: Facilitator Information: Name: Address: Email: Phone: Payment: You will be paid one installment after you have completed two sessions and the remainder plus mileage after you have completed the series and sent in your written evaluation. Stipend: $200 x number of sessions (2/4) = + $ 50.00 Stipend if Pre-visit made = Mileage: (RT from your address to the address of the program) x4= x .55 per mile = Tolls: Stipend and Mileage Total: Signatures (electronic is fine): I agree to facilitate the number of programs detailed in this contract and to complete an evaluation within 2 weeks of the series completion. Facilitator Signature: Date: Connections Coordinator: Date: Please attach completed form to: NH Humanities, Dolloff Bldg, 117 Pleasant St., Concord, NH 03301 Fax: 603-224-4072 Ph: 603-224-4071
New Hampshire Humanities completes this section: Facilitator Information: Name: Address: Email: Phone: Payment: You will be paid one installment after you have completed two sessions and the remainder plus mileage after you have completed the series and sent in your written evaluation. Stipend: $200 x number of sessions (2/4) = + $ 50.00 Stipend if Pre-visit made = Mileage: (RT from your address to the address of the program) x4= x .55 per mile = Tolls: Stipend and Mileage Total: Signatures (electronic is fine): I agree to facilitate the number of programs detailed in this contract and to complete an evaluation within 2 weeks of the series completion. Facilitator Signature: Date: Connections Coordinator: Date: Please attach completed form to: NH Humanities, Dolloff Bldg, 117 Pleasant St., Concord, NH 03301 Fax: 603-224-4072 Ph: 603-224-4071