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.

Do you have any questions related to RCN contract funds or data in response to the school closure? Visit the RCN FAQ page for answers to your questions.

2020-2021 Reports and Applications

Reports	Form	Due Date
2020-2021 RCN Application	RCN Application	June 30, 2020

2019-2020 Reports and Applications

Reports	Forms	Due Date
Beginning of Year Target Student Reporting Form	K-12 Beginning of Year Target Student Reporting Form Printable K-12 Target Student Reporting Form BYF Beginning of Year Target Student Reporting Form Printable BYF Target Student Reporting Form Target Student Parent Permission	October 25, 2019 (Collected by October 14, 2019)
2019-2020 Contract Requirements Worksheet	Contract Requirements Worksheet For Multi-County RCN OR Contract Requirements Worksheet For Single-County RCN	October 28, 2019
2019-2020 Mid-Year Progress Report	Mid-Year Contract Progress Report Updated RCN Contract Requirements Worksheet Peer to Peer Support Program Log (in your RCN Dropbox folder) Financial Expenditure Report Mid-year Invoice (if payment is sought)	February 3, 2020
End of Year Target Student Reporting Form	K-12 End of Year Target Student Reporting Form Printable K-12 End of Year Target Student Reporting Form BYF End of Year Target Student Reporting Form Printable BYF End of Year Target Student Reporting Form	May 29, 2020 (Collect after April 13, 2020)
2019-2020 End of Year Progress Report	End of Year Contract Progress Report RCN Trainings Report Form RCN EPLI Trainers Report EPLI Level 1 Individual Trainer Reports Final RCN Contract Requirements Worksheet Capacity Building Planning Tool Capacity Building Tool - Sample For your individual RCN Capacity Building Tool, contact START or your RCN Dropbox folder Secondary Transition Recommendations Implementation Checklist (0-1) Completed Peer to Peer Fidelity Checklists (5) Financial Expenditure Report Final Invoice	July 17, 2020

Financial 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

Planning and Running Effective RCN Meetings

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

View the full 2019-2020 RCN contract priorities here.

Priority Area #1: PD with Impact

Tools to Support Goals

START Training Curricula

EPLI Trainer Application and Reporting Tools

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

Tools to Support Goals

IEP Implementation Coaching Checklist and Process Tools

Coaching Tool Kit

Individual Student Data Collection Forms: Engagement, Independence & Social (required for the K-12 Target Student Data Form)

CETA-R

USAPT Online System

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
- 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.
CETA-R: Complete by January 1^st and set goals; data submitted with EOY report
USAPT: Complete by January 1^st and set goals; data submitted with EOY report

Priority Area #3: BYF – Secondary Transition

Tools to Support Goals

V3 Discovery Checklist and Process Tools

Michigan Autism Council Secondary Transition Recommendations Checklist

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
- 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.
Secondary Transition Recommendations Checklist (if used to meet contract requirements) (submitted with EOY report)

Priority Area #4: Peer to Peer Support Programs

Tools to Support Goals

Peer to Peer Support Resources

Peer to Peer Fidelity Checklist

Peer to Peer Log Instructions

Peer to Peer Community of Practice Responsibility Checklist

Peer to Peer Data Package Summary for PPII Sites

Peer to Peer Innovation and Impact Sites

Options for Collecting ISD-Wide Peer to Peer Data

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
- Guidance for Selection of Peer to Peer Community of Practice Members

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

Tools to Support Goals

Individual Student Data Collection Forms: Engagement, Independence & Social (required for the K-12 Target Student Data Form)

CETA-R

USAPT Online System

V3 Discovery Checklist and Process Tools

Michigan Autism Council Secondary Transition Recommendations Checklist

Peer to Peer Support Resources

Peer to Peer Fidelity Checklist

Community Conversation Resources

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
CETA-R
USAPT
Secondary Transition Recommendations Checklist (submitted with EOY report)
Completed Peer to Peer Fidelity Checklists (submitted with EOY Report)
K-12 and BYF Target Student Data Forms

Page last modified June 10, 2020

Report a problem with this page