RCN Application and Contract Forms

If you have any questions, or need assistance, please contact your START RCN Representative or Jana Benjamin, (616) 331-6482. Thank you for your leadership and everything you do to improve supports for students with ASD in Michigan.

Please note: This page will be updated regularly as forms and links become available. 


RCN Contract & Reporting Requirements Summary

Reports 

Forms

Due Date

Beginning of Year Target Student Reporting Form

  • K-12 Beginning of Year Target Student Reporting Form
  • BYF Beginning of Year Target Student Reporting Form

October 25, 2019
(Collected by October 14, 2019)

2019-2020 Contract Requirements Worksheet

October 28, 2019

2019-2020 Mid-Year Progress Report

February 3, 2020

End of Year Target Student Reporting Form

  • K-12 End of Year Target Student Reporting Form
  • BYF End of Year Target Student Reporting Form

May 29, 2020
(Collected after April 13, 2020)

2020-2021 RCN Application

  • RCN Application

June 30, 2020

2019-2020 End of Year Progress Report

July 17, 2020


Additional Forms and Information

  • Please see the RCN Contract Spending Guidelines for allowable and non-allowable expenses
  • Financial Expenditure Report
  • Capacity Building Tool - Sample
    • For a copy of your individual RCN Capacity Building Tool, contact the START office or check your RCN Dropbox folder
  • Target Student Reporting Form
    • If your RCN Target Student is the focus student for a START Intensive Training Team, you will enter the Target Student data using the Intensive Training data link (emailed to the team from the START office). Please make a note on the RCN Contract Worksheet that your RCN Target Student is part of a START Intensive Training team. 
  • Use the RCN Pacing Guide as a schedule to help guide you through the RCN Contract year. It includes important activities, data collection, and reporting by month.

Contract & Reporting Requirements by Priority Area

Priority Area #1: PD with Impact

Goal Requirements

  • Develop & implement a PD plan with START-approved trainers
    • Participate in START IT
    • Mini IT
    • Single Trainings
  • Submit at least one PD per semester to post on the START website

Specific Reporting Requirements and Forms


Priority Area #2: Coaching for Implementation of EBP

Goal Requirements

  • Establish/Sustain a coaching structure at the district and ISD level with coach leaders and building coaches
  • Single County RCN (4 data sets)
    • 2 target students using the IEP Implementation Coaching Checklist AND 1-2 additional target students using the IEP Implementation Coaching Checklist
    • OR 1-2 CETA-R 
    • OR 1-2 USAPT
  • Multi County RCN (2 data sets per ISD)
    • 1 target student using the IEP Implementation Coaching Checklist AND 1 additional target student using the IEP Implementation Coaching Checklist
    • OR 1 CETA-R
    • OR 1 USAPT

Specific Reporting Requirements & Forms

  • Mid-Year/End of Year Contract Progress Report
  • Capacity-Building Tool (submitted with EOY reports)
  • K-12 Target Student Reporting Form
  • CETA-R: Complete by January 1st and set goals; data submitted with EOY report
  • USAPT: Complete by January 1st and set goals; data submitted with EOY report

Priority Area #3: BYF – Secondary Transition

Goal Requirements

  • 3 data sets per RCN
  • 1 target transition-age students using V3 Discovery AND 1 additional target student using V3 Discovery
  • OR 1 secondary transition program evaluation using the Michigan Autism Council Transition and Adult Service Committee Recommendations Checklist

Specific Reporting Requirements & Forms

  • Mid-Year/End of Year Contract Progress Report
  • BYF Target Student Reporting Form
  • Secondary Transition Recommendations Checklist (if used to meet contract requirements) (submitted with EOY report)

Priority Area #4: Peer to Peer Support Programs

Goal Requirements

Specific Reporting Requirements & Forms

  • Mid-Year/End of Year Contract Progress Report
  • Completed Peer to Peer Fidelity Checklists (submitted with EOY Report)
  • Updated Peer to Peer Support Program Log (submitted with MY Report)

Priority Area #5: Family & Community Engagement

Tools to Support Goals

Passport

START Parent Info Portal

Goal Requirements

  • Utilize the passport with families
  • Involve families and MAF in RCN meetings
  • Support attendance at the START Conference for at least two parents who are involved with your RCN or ISD

Specific Reporting Requirements & Forms

  • Mid-Year/End of Year Contract Progress Report

Priority Area #6: Optional RCN Activities

Goal Requirements

  • Additional Priority 2 Target Students, Classrooms, or Buildings:
    • Additional target student(s) using the IEP Implementation Coaching Checklist
    • AND/OR Additional CETA-R(s)
    • AND/OR Additional USAPT(s)
  • Additional Priority 3 Secondary Transition Target Students or Programs:
    • Additional target student(s) using V3 Discovery
    • AND/OR Additional secondary transition program evaluation using the Michigan Autism Council Transition and Adult Service Committee Recommendations Checklist
  • Additional Priority 4 Peer to Peer Programs or Fidelity Tool Data:
    • Additional new or significantly expanded peer to peer support program(s)
    • AND/OR Additional Peer to Peer Fidelity Checklist(s)
  • Peer to Peer Regional Coach/Coordinator
  • Community Conversation
    • Plan and hold a new Community Conversation related to RCN contract priorities (e.g., secondary transition, peer to peer support, collaboration with community providers, or family engagement)
    • AND/OR Substantial follow-up from a prior Community Conversation
  • Other approved activities furthering RCN Contract Priorities

Specific Reporting Requirements & Forms

  • Mid-Year/End of Year Contract Progress Report
  • K-12 Target Student Data Form
  • CETA-R
  • USAPT
  • BYF Target Student Data Form
  • Secondary Transition Recommendations Checklist (submitted with EOY report)
  • Completed Peer to Peer Fidelity Checklists (submitted with EOY Report)