Services / ESY services entry
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Some items need revision (cannot save).
*Denotes required items
Last Name
First Name
Meeting Date
1. Items for all students:
Teacher/provider name*
Teacher/provider name*
(The teacher name does
not
appear on the printed form, only the teacher code.)
If the teacher is not listed in the pop-up, try entering the name or code here:
School*
School*
If the school is not listed in the pop-up, try entering the school name or code here:
Service*
Service*
Primary
Primary
Yes
No
Yes
No
Report to CASEMIS
Yes
No
Yes
No
Start date*
Start date*
End (evaluation) date
End (evaluation) date
Location type*
Location type*
Provider/responsible agency*
Provider/responsible agency*
(appears on the printed form)
Extended school year
Extended school year
Yes
No
Yes
No
2. For infant (age 0-2) or mental health services:
The following items are required for infant and mental health services. However, they can also be used for non-infant services as well.
Provider type
Provider type
(*infant/MHS)
Frequency code
Frequency code
(*infant/MHS)
Duration, minutes per session
Duration, minutes per session
(*infant/MHS)
3. Other items:
Auxiliary service location
Auxiliary service location
Delivery model
Delivery model
Consult
Consult
Yes
No
Yes
No
LEA district
LEA district
4. For non-infant, non-MHS services:
Duration (other description)
Duration (other description)
Note: This item prints as the duration, provided that the "Duration, minutes per session" (infant section) is zero.
(Describe if other:)
Frequency (other)
Frequency (other)
(Describe if other:)
Sessions per week
Sessions per week
Note: This item prints as the frequency, provided that no "Frequency code" (infant section) and no "Frequency (other)" values are specified.
5. For discontinued services:
The following items should be specified when the service has been discontinued:
Drop date
Drop reason
Drop reason
(primary service only)
Drop code or reason
Drop code or reason
(non-primary service only)
5. For discontinued services:
(for information only, no entry permitted here)
Drop date
Primary drop reason
-
Non-primary drop reason
-
*Required items