STIPEND RECIEPT
I, ______________, confirm
that I have received a $[AMOUNT]
stipend for my participation in a focus group discussion for the
Region VIII Office of the Assistant Secretary for Health, Office on
Women’s Health Assessment of the Impact of Energy Development
on the Behavioral Health of Women in Western North Dakota and
Eastern Montana on
(date).
_________________________________________________
Participant's signature
_________________________________________________
HRiA staff signature
STIPEND RECIEPT
I, _______________, confirm
that I have received a $[AMOUNT]
stipend for my participation in a focus group discussion for the
Region VIII Office of the Assistant Secretary for Health, Office on
Women’s Health Assessment of the Impact of Energy Development
on the Behavioral Health of Women in Western North Dakota and
Eastern Montana] on
(date).
_________________________________________________
Participant's signature
_________________________________________________
HRiA staff signature
STIPEND RECIEPT
I, ______________, confirm
that I have received a $[AMOUNT]
stipend for my participation in a focus group discussion for the
Region VIII Office of the Assistant Secretary for Health, Office on
Women’s Health Assessment of the Impact of Energy Development
on the Behavioral Health of Women in Western North Dakota and
Eastern Montana] on
(date).
_________________________________________________
Participant's signature
_________________________________________________
HRiA staff signature
| File Type | application/msword |
| Author | Leslie Fox |
| Last Modified By | SYSTEM |
| File Modified | 2017-08-22 |
| File Created | 2017-08-22 |