Authorization and Consent

January 12, 2024


Authorization and Consent

Please be advised that I have retained the services of Debra Mitchell Educational Consultant
and Associates, Inc. regarding the education of (Student) as undersigned and a signed
contract is on file. I (Barbara Mellen-Wilson) do hereby authorize the recipient to furnish
Debra Mitchell any requested information and/or records related to my child’s education.
This authorization includes my consent to the recipient discussing my child’s education,
educational plan, and any other subject related to my child’s right to a Free and Appropriate
Public Education with Debra Mitchell.
Date: __________________ /s/: ___________________________
Legal Counsel Addendum: Attorney/Service Provider ( )

FBO: (Student)

I. Conflicts of Interest and Ethical Conduct.

The educational consultants of Debra Mitchell Educational Consultant and Associates, Inc.
(DMECA) are either dedicated current or former employees of Hillsborough County Public
Schools. To avoid a conflict of interest regarding HCPS Board Policy 6460.01, 1129, 3129,
4129 which states the following: [initial where you agree]
Please initial in agreement

a. No Educational Consultant from Debra Mitchell Educational Consultant and
Associates, Inc.(DMECA) has violated HCPS Board Policy 6460.01, 1129, 3129,
4129, which states: Employees shall not engage in business, private practice of their
profession, the rendering of services, or the sale of goods of any type where advantage
is taken of any professional relationship they may have with any student, client, or
parents of such students, or clients in the course of their employment with the district.
b. I have not had solicited contact with any Educational Consultant from Debra Mitchell
Educational Consultant and Associates, Inc. (DMECA) prior to seeking services from
DMECA. ______________
c. I have not been solicited by any person from Debra Mitchell Educational Consultant
and Associates, Inc. (DMECA) prior to seeking their services. _____________

Initial in agreement

1. Term and Termination.

1.1.1 Term. The term of this Agreement shall be for a [Insert period]
commencing on the [insert date] through [insert date] (the “Term”), unless
earlier terminated as provided herein, or unless extended by mutual
agreement expressed in writing signed by both parties prior to the
expiration of the Term.
1.1.2 Termination. Notwithstanding anything in this Agreement to the contrary:
1.1.3 The agreement will be terminated by DMECA if the clients Attorney
causes a liability to the consultants by not using the contact information for
DMECA. The consultant will continue to work with the client but will no
longer work independently or Collaboratory with the attorney. _________
1.1.4 Injunctive Relief in Event of Breach. Because of the unique nature of the
Confidential Information the client/attorney and service provider
acknowledge that liability may be deemed if a conflict of interest is
determined. Client, attorney, and/or service provider understands and
agrees that Consultant would suffer irreparable harm if the Clients elected
attorney/service provider fails to comply with any of his/her obligations.
1.1.5 The attorney collaboration fee will not be return to the client in the
event of a breach of contract by the attorney/service provider. (clients
initial in agreement)
2. Independent Contractor Status.

2.1.1 Neither the Consultant nor the Consultant’s employees or personnel shall
receive any training from the Attorney/Service Provider elected by the
clients for the professional skills necessary to perform the Services required
by this Agreement; and
2.1.2 Neither the Consultant nor Consultant’s employees or personnel shall be
required by the Client, Attorney/Service provider to devote full-time to the
performance of the Services required by this Agreement.

Consultants contact information:
Debra Mitchell Educational Consultant and Associates, Inc.
PO BOX 311252
Tampa, FL 33680
Telephone: (813) 693-1486
NO other contact information is to be use, if any other email is utilized it serves as a breach
of contract.
IN WITNESS WHEREOF, the Parties hereto have executed this Agreement on the dates
written hereunder.
Attorney/Service provider/s? ____________________________ Date: _______________
Name: (Attorney/Service

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