Page of DIVISION OF VOCATIONAL REHABILITATION (DVR) COMMUNITY REHABILITATION PROGRAM (CRP) AFP NUMBER PRE-EMPLOYMENT TRANSITION SERVICES (PRE-ETS) Service Delivery Outcome Plan: Pre-ETS Job Shadow DVR CUSTOMER CRP CONTRACTOR CRP REPRESENTATIVE’S NAME SERVICE DELIVERY STAFFING INTERVALS From: To: PARTY NUMBER EXPECTED OUTCOME PURCHASE AND PAYMENT CRITERIA COST ($) RESPONSIBLE Pre-Employment Transition Services Job Shadow is a one to $ MAXIMUM TOTAL OUTCOME FEE: five-hour observation at a business in the community. The job Fee for each Job Shadow is $125 per hour for up to shadow should be located at a business or organization not five hours. Maximum payment for each SDOP is related / connected to the CRP’s own agency. $1250, based on two Job Shadow experiences. CRP This SDOP provides for up to two (2) Job Shadow Specific CRP services include: Student experiences at two (2) different for up to five (5) Developing the Job Shadow site(s) based on student VRC hours each. interests Contractor agrees to provide up to Job Helping student prepare questions for the employer Shadow experiences. Helping student plan appropriate grooming Helping student plan transportation Outcome fee paid to Contractor upon receipt of Accompany student to the site(s) invoice and outcomes achieved as described in the Helping student prepare and deliver a follow-up note to the Service Delivery Outcome Report (SDOR). employer Fee is based on direct student activities, and does Post-Job Shadow debriefing with student not include report writing time. Student First Name: Specific areas of interest identified by SDOR must be written directly to the student, and provided to both the student and DVR VRC. Enter interest area 1. Report must include: Enter interest area 2. CRP Provider representative name Dates and hours of all activities Enter interest area 3. Evidence of student skill gains in identified training areas Specific recommendations for further student exploration and experience Travel time at a fixed rate of $35 per hour in $ increments if service delivery occurs more than Student Student will participate in all Job Shadow activities, and will fifty (50) miles from the contractor’s nearest staffed attend all scheduled meetings. office location. CUSTOMER / GUARDIAN SIGNATURE DATE IL SIGNATURE DATE DVR SIGNATURE DATE $ Signature by each party indicates agreement to the contents of this plan.
DIVISION OF VOCATIONAL REHABILITATION (DVR) COMMUNITY REHABILITATION PROGRAM (CRP) PRE-EMPLOYMENT TRANSITION SERVICES (PRE-ETS) Service Delivery Outcome Plan: Pre-ETS Job Shadow Page of AFP NUMBER DVR CUSTOMER CRP CONTRACTOR CRP REPRESENTATIVE’S NAME SERVICE DELIVERY From: To: STAFFING INTERVALS NUMBER EXPECTED OUTCOME PARTY RESPONSIBLE PURCHASE AND PAYMENT CRITERIA COST ($) Pre-Employment Transition Services Job Shadow is a one to five-hour observation at a business in the community. The job shadow should be located at a business or organization not related / connected to the CRP’s own agency. MAXIMUM TOTAL OUTCOME FEE: Fee for each Job Shadow is $125 per hour for up to five hours. Maximum payment for each SDOP is $1250, based on two Job Shadow experiences. This SDOP provides for up to two (2) Job Shadow experiences at two (2) different for up to five (5) hours each. Contractor agrees to provide up to Job Shadow experiences. Outcome fee paid to Contractor upon receipt of invoice and outcomes achieved as described in the Service Delivery Outcome Report (SDOR). Fee is based on direct student activities, and does not include report writing time. SDOR must be written directly to the student, and provided to both the student and DVR VRC. Report must include: CRP Provider representative name Dates and hours of all activities Evidence of student skill gains in identified training areas Specific recommendations for further student exploration and experience $ Specific CRP services include: Developing the Job Shadow site(s) based on student interests Helping student prepare questions for the employer Helping student plan appropriate grooming Helping student plan transportation Accompany student to the site(s) Helping student prepare and deliver a follow-up note to the employer Post-Job Shadow debriefing with student Specific areas of interest identified by Student First Name: 1. Enter interest area 2. Enter interest area 3. Enter interest area CRP Student VRC Travel time at a fixed rate of $35 per hour in increments if service delivery occurs more than fifty (50) miles from the contractor’s nearest staffed office location. $ Student will participate in all Job Shadow activities, and will attend all scheduled meetings. Student CUSTOMER / GUARDIAN SIGNATURE DATE IL SIGNATURE DATE DVR SIGNATURE DATE $ Signature by each party indicates agreement to the contents of this plan.
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