Page of DIVISION OF VOCATIONAL REHABILITATION (DVR) INDEPENDENT LIVING (IL) SERVICE PROVIDER AFP NUMBER PRE-EMPLOYMENT TRANSITION SERVICES (PRE-ETS) Service Delivery Outcome Plan: Pre-ETS IL Peer Mentoring DVR CUSTOMER IL CONTRACTOR IL REPRESENTATIVE’S NAME SERVICE DELIVERY DATES STAFFING INTERVALS From: To: NUMBER EXPECTED OUTCOME PARTY RESPONSIBLE PURCHASE AND PAYMENT CRITERIA COST ($) Pre-Employment Transition Services IL Peer Mentoring is MAXIMUM TOTAL OUTCOME FEE: $ designed to help a student receive peer mentoring from Fee per hour is $72.00 for up to hours. individuals with disabilities working in competitive integrated Outcome fee paid to Contractor upon receipt of employment or engaged in post-secondary education or invoice and outcomes achieved as described in training. the Service Delivery Outcome Report (SDOR). IL Provider The contractor will identify an appropriate peer mentor(s) to Fee is based on direct student activities, and coordinate and support peer mentoring activities. does not include report writing time. IL Provider SDOR must be written directly to the student, Specific peer mentoring areas include developing goals for and provided to both the student and DVR Student mentor / mentee activities. Types of goals may include the VRC. following areas: VRC Independent living Report must include: Community building IL Provider representative name Navigating college life Dates and hours of all activities Making friends on the job Evidence of student gains in identified Decision-making training areas Developing friendships Specific recommendations for further Setting boundaries student exploration and experience Student First Specific Peer Mentoring training goals for $ Travel time at a fixed rate of $35 per hour in Name include: quarter-hour increments if service delivery occurs more than fifty (50) miles from the contractor’s nearest staffed office location. Student Student will participate in all IL Peer Monitoring activities, and will attend all scheduled meetings. CUSTOMER / GUARDIAN SIGNATURE DATE IL SIGNATURE DATE DVR SIGNATURE DATE TOTAL $ Signature by each party indicates agreement to the contents of this plan.
DIVISION OF VOCATIONAL REHABILITATION (DVR) INDEPENDENT LIVING (IL) SERVICE PROVIDER PRE-EMPLOYMENT TRANSITION SERVICES (PRE-ETS) Service Delivery Outcome Plan: Pre-ETS IL Peer Mentoring Page of AFP NUMBER DVR CUSTOMER IL CONTRACTOR IL REPRESENTATIVE’S NAME SERVICE DELIVERY DATES From: To: STAFFING INTERVALS NUMBER EXPECTED OUTCOME PARTY RESPONSIBLE PURCHASE AND PAYMENT CRITERIA COST ($) Pre-Employment Transition Services IL Peer Mentoring is designed to help a student receive peer mentoring from individuals with disabilities working in competitive integrated employment or engaged in post-secondary education or training. MAXIMUM TOTAL OUTCOME FEE: Fee per hour is $72.00 for up to hours. 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: IL Provider representative name Dates and hours of all activities Evidence of student gains in identified training areas Specific recommendations for further student exploration and experience $ The contractor will identify an appropriate peer mentor(s) to coordinate and support peer mentoring activities. IL Provider Specific peer mentoring areas include developing goals for mentor / mentee activities. Types of goals may include the following areas: Independent living Community building Navigating college life Making friends on the job Decision-making Developing friendships Setting boundaries IL Provider Student VRC Specific Peer Mentoring training goals for Student First Name include: Travel time at a fixed rate of $35 per hour in quarter-hour increments if service delivery occurs more than fifty (50) miles from the contractor’s nearest staffed office location. $ Student will participate in all IL Peer Monitoring activities, and will attend all scheduled meetings. Student CUSTOMER / GUARDIAN SIGNATURE DATE IL SIGNATURE DATE DVR SIGNATURE DATE TOTAL $ Signature by each party indicates agreement to the contents of this plan.
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