Counseling Form

With this request for business management and technical assistance services, I understand that any consultants or other personnel assigned to assist me will treat all information and data received in complete confidence. I understand this to be a management and technical assistance service. In consideration of the requested service, I hereby waive my rights to any and all claims arising from this service against any of the entities, personnel, or counselors involved in this assistance program. I agree to cooperate should I be selected to participate in surveys designed to evaluate these assistance services. I further understand that any consultant working with me has agreed not to: (1) recommend goods or services from sources in which he/she has an interest and (2) accept fees or commissions developing from this counseling relationship. Please note: By signing your full name below you are accepting the agreement above.