Services / ESY services entry
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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 teacher code here:
You can also select by teacher assignment.
 
School* School*
  If the school is not listed in the pop-up, try entering the school name or code here:
 
Service* Service*
Primary Primary
Report to CASEMIS
Start date* Start date*
End (evaluation) date End (evaluation) date
Location type* Location type*
Provider type* Provider type* Provider/responsible agency* Provider/responsible agency*
(appears on the printed form)
  NOTE: A provider type of "California Childrens Services 310" for a current service will cause the CCS box to be checked on the Educational Services form (5B).
 
Extended school year Extended school year
 

2. For infant (age 0-2) services:
The following items are required for infant services. However, they can also be used for non-infant services as well. †In addition, they may be still be required for state submissions of educationally-related mental health services (ERMHS).
 
Provider type Provider type  
  NOTE: A provider type of "California Childrens Services 310" for a current service will cause the CCS box to be checked on the Educational Services form (5B).
 
Frequency code Frequency code  
Duration, minutes per session Duration, minutes per session  
 

3. Other items:
 
Auxiliary service location Auxiliary service location
Delivery model Delivery model
Consult Consult
LEA district LEA district
Comments Comments
Provider/responsible agency Provider/responsible agency
 

4. For non-infant services:
 
 

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