10. Briefly describe pertinent academic and behavioral information for each year. This information must be based on a student’s individualized educational program (IEP), report card, or any other progress reports. Fiscal Year Name of Facility or LEA Academic Information Behavioral Information 11. Non-educational Community-Based Support Services. It is required that a meeting be held with the CRCG or a group of people knowledgeable about the student to determine whether or not these services are needed. Indicate need(s) for which funds are being requested. For each need, indicate service(s), description of service(s), proposed service provider(s), and status (new, continued, or revised). NEED(S) Indicate each need for which funds are being requested. Each need should be directly related to the behavior described in Question 4. SERVICE(S) Service(s) must agree with the cost analysis (see Question 12) indicating the service to meet each need for which funds are being requested. DESCRIPTION OF SERVICE(S) Describe each service. Be specific as to how the service is non-educational and/or different from educational services. PROPOSED SERVICE PROVIDER(S) Indicate whether the provider is the local MRA/MHA, local school district, or other provider.
10. Briefly describe pertinent academic and behavioral information for each year. This information must be based on a student’s individualized educational program (IEP), report card, or any other progress reports. Fiscal Year Name of Facility or LEA Academic Information Behavioral Information 11. Non-educational Community-Based Support Services. It is required that a meeting be held with the CRCG or a group of people knowledgeable about the student to determine whether or not these services are needed. Indicate need(s) for which funds are being requested. For each need, indicate service(s), description of service(s), proposed service provider(s), and status (new, continued, or revised). NEED(S) Indicate each need for which funds are being requested. Each need should be directly related to the behavior described in Question 4. SERVICE(S) Service(s) must agree with the cost analysis (see Question 12) indicating the service to meet each need for which funds are being requested. DESCRIPTION OF SERVICE(S) Describe each service. Be specific as to how the service is non-educational and/or different from educational services. PROPOSED SERVICE PROVIDER(S) Indicate whether the provider is the local MRA/MHA, local school district, or other provider.
Application%20Form%2018-19.docx