Services / ESY Services
Last Name
First Name
Meeting Date
Teacher*
Teacher*
If the teacher is not listed in the pop-up, try entering the name or code here:
Provider type (*infants/mental health svcs.)
Provider type (*infants/mental health svcs.)
Individual/Group
Individual/Group
School*
School*
If the school is not listed in the pop-up, try entering the school name or code here:
Location type*
Location type*
Service*
Service*
Session note
Session note
Auxiliary service location
Auxiliary service location
Primary service
Primary service
Yes
No
Yes
No
Report to CASEMIS
Yes
No
Yes
No
Extended school year
Extended school year
Yes
No
Yes
No
Consult
Consult
Yes
No
Yes
No
Start date*
Start date*
End (evaluation) date
End (evaluation) date
Frequency code (*infants/mental health svcs.)
Frequency code (*infants/mental health svcs.)
Duration, minutes per session (*infants/mental health svcs.)
Duration, minutes per session (*infants/mental health svcs.)
Duration (other description)
Duration (other description)
Sessions per week
Sessions per week
Frequency (other)
Frequency (other)
LEA district
LEA district
Drop date
Primary drop reason
Primary drop reason
Non-primary drop code-reason
Non-primary drop code-reason
(non-primary service only)
For information only:
Drop date
Primary drop reason
-
Non-primary drop reason
-
*Required items