HomeMy WebLinkAboutSupporting Document5(see attachment VI H, supporting documents Case notes to support
service log, job development log, monthly summary and travel
reimbursement logs)
�CP
UNITED CEREBRAL PALSY ASSOCIATION OF MIAMI, INC.
1411 NW 14 Ave., Miami, Fl 33125
MDCPS SUPPORTED EMPLOYMENT
MONTHLY SUMMARY
Student Name: School Name: Mo./Yr.:
Student ID# DOB M F
o IEP Date
o Work Documents
o Issues with Parental Support
o Type of work interested in
o Number of Job Applications Submitted
o Number of Job Interviews
o Number of Job Offers
o Place of Employment
o Start /Termination Date of Employment
o Additional Comments:
Job Coach Signature Date
UCP
UNITED CEREBRAL PALSY ASSOCIATION OF MIAMI, INC.
Travel / Reimbursement Log
(Local & Out of Town Expenses)
UCP EMPLOYEE NAME:
UCP EMPLOYEE NUMBER: PROGRAM/DEPT: MONTH/DAY/YR.:
DATE
PURPOSE OF LOCAL TRIP OR EXPENSE
MILEAGE
FROM
MILEAGE
TO
LOCAL
MILEAGE X .38
TOLLS
MEALS, LODGING,
CALLS, TRANSP.,
MISCELLANEOUS
DAILY TOTAL
Employee Signature/Date
Director Signature/Date
TOTAL PAGE $
MONTHLY TOTAL: $
Supervisor Signature/Date
Associate Director/Date
Director complete for
Bookkeeper:
8127 (mileage) $
8129 (phone) $
A/C Unit:
President/CEO or Executive Director
DIRECTIONS: 1. Employee must submit tog at least monthly.
Z. Employee may submit tog for supervisory approval every payday.
3. Human Resources will submit logs to Bookkeeper for review and coding on the spreadsheet on Monday after payday.
4. Bookkeeper will make copy of spreadsheet for Human Resources for submission with payroll cover sheet on Monday. (By 11:00 a.m.)
O. Employee will be reimbursed for travel expense via their paycheck.
NOTE: UCP WILL NOT REIMBURSE AN EMPLOYEE FOR TRAVEL RELATED EXPENSES PAST 90 DAYS EXCEPT FOR SEPTEMBER EXPENSES WHICH MUST BE
SUBMITTED BY OCTOBER 30, DUE TO FISCAL YEAR END.
Rev. 11/05
SuPDorted En1Dloyment_
se Notes
SUPPORTED EMPLOYMENT
30-Day Development Review
For Period
I have reviewed the job development efforts for this period with my Employment Consultant. I
agree/disagree with job development to date.
Notes/Comments:
Consumer Signature
Employment Consultant
JOB DEVELOPMENT CONTACTS
Company Name
Address
Contact Name
Phone#
Date & Type of Contact
In Person/Phone/Letter
Amount of Time
Comments/Results
'p.m%
IVU/WI-UAUt LL)UN I Y PUBLIC SCHOOLS
Division of Exceptional Student Education
Weekly Contact Log for Supported Employment Job Coaches
county
Name
of Job Coach: Week of :
Date
Student Name
School
Service
Code
Time
Total
Hours &
Minutes
Location
of Service
Comments
Initials of
Certifying
Personnel
From
To
CODES
JD - Job Development FU - Follow Up
SS - Student Screening TC - Teacher Consultation
JP - Job Placement RK - Record Keeping
OJT - On the Job Training JCT - Job Coach Travel
I certify that these
services have been
provided to the above
named students.
Job Coach Signature Date
Agency Administrator Date
ESE Dept. Chair/Program Specialist Date
Student's Employer Date
Student's Employer Date
Supported Employment Database
School year 2006-2007
Student's name
ID #
Job Coach
Agency
School Name
IEP date
Initial date of
employment
Place of
employment
Status Code*
& Date
* A= Job Searching
B= Currently Employed
C= Graduated
D= Lost Job