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 |
|
October 25, 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 |
|
May 29, 2020 |
|
2020-2021 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
- Your Financial Expenditure Report must be a finance report from your Business/Finance office for actual expenditures to date and;
- You will also need to submit an invoice requesting reimbursement for expenditures to date charged to your RCN contract.
- Example of completed Financial Expenditure Report
- Make sure you have followed the RCN Contract Spending Guidelines for all expenses
- 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
- Mid-Year/End of Year Contract Progress Report
- RCN Trainings Report Form (MY/EOY Report Packet)
- RCN EPLI Trainers Report Form (MY/EOY Report Packet)
- EPLI Level 1 Trainer Individual Report
- PD posted on START website
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
- 3 new or significantly expanded peer to peer support programs
- 5 Peer to Peer Fidelity Checklists
- Peer to Peer Log
- 2 RCN representatives for the Peer to Peer Community of Practice
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
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)