Contract for Consultant
Client:_____________________________________________________
Address:____________________________________________________
Telephone number(s):_________________________________________
E-mail address:______________________________________________
Directions:___________________________________________________
Contact person:________________________________ Title:___________________
Address: (if different from facility)__________________________________________
Telephone number:__________________________ e-mail address:_______________
GOAL: The purpose of this consultation is to:
OBJECTIVES:
METHOD OF ASSESSMENT:
The consultant will spend _____ hours through _____ (#) visits on the following
dates:
During that time the consultant will perform the following tasks:
Method of assessing consultant:_____________________________________________
Cost for consultant: __________
($100/hour for on-site; $50/hour for telephone conferencing; $25/e-mail) Cost of
Travel:_____________
Cost of Telephone calls:_______
Per Diem food/lodging:________
Signature of Client Representative Date Signature of CDF Representative Date
Signature of Consultant Date
Return to Consultant.