Student service
Last Name First Name Date of birth

1. Items for all students:
 
Teacher* Teacher*
  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
Report to CASEMIS
Start date* Start date* Pick a date
End (evaluation) date End (evaluation) date Pick a date
Location type* Location type*
Extended school year Extended school year
 

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 code (Other:)   
Delivery model (individual/group)
Disabling condition Disabling condition  (primary only)
Isolated site
Regional program
Consult
LEA district LEA district
Session note
Infant agency Infant agency  (obs.)
Infant location Infant location  (obs.)
Associated student address
 

4. For non-infant, non-MHS services:
 
Duration (other description) Duration (other description)
(Describe if other:)   
 
Frequency (other) Frequency (other)
(Describe if other:)   
 
Sessions per week Sessions per week
 

5. For discontinued services:
 
Drop date Pick a date
Drop reason Drop reason  (primary service only)
Drop code or reason Drop code or reason (non-primary service only)
CSIS exit reason CSIS exit reason
 

*Required items