WP E-Signature by Approve Me - Sign Documents Using WordPress -

CCSS Application

----------------------------------- Page 1 -----------------------------------

----------------------------------- Page 2 -----------------------------------

----------------------------------- Page 3 -----------------------------------

----------------------------------- Page 4 -----------------------------------

----------------------------------- Page 5 -----------------------------------

----------------------------------- Page 6 -----------------------------------

>/p>

3. Program Supervisor's name

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Timestamp

Audit

December 17, 2020 6:53 am MST

CCSS Application Uploaded by E-Signature Forms - e-signatures@nmrecovery.org IP 82.34.28.98

October 8, 2021 9:23 am MST

Julie Ruth - julie@lokacreative.com added by E-Signature Forms - nmresigform@clearsky.systems as a CC'd Recipient Ip: 86.163.151.141

October 8, 2021 12:08 pm MST

Julie Ruth - julie@lokacreative.com added by E-Signature Forms - nmresigform@clearsky.systems as a CC'd Recipient Ip: 86.163.151.141