Job Coaching for the Promotion of Sustainable Open Employment
Contracts Evaluation Form · Extended Services for Transition; CE Employment Outcome CE Job...
2
Contractor Name: Dates from: Dates to: mm/dd/yyyy mm/dd/yyyy SE SE HC ER JP ESS JOBS Total Combined Revenue Revised 04/03/2020 ESS-A-010 Felony Conviction Deaf / Blind Contracts Evaluation Form ER, ESS, JP, JOBS & SE Contracts Page 1 of 2 Placements completed 4 week Milestones completed Total Combined Revenue from page 1 and 2: ESS training services completed EM Milestones completed Stabilization Milestones completed 8 week Milestones completed Total Revenue Claimed for each contract: Incentives claimed based on: Assessment to placement percentage Average hours worked per week at closure Legally Blind HIV / AIDS SED Hourly Wage Deaf, primary communication sign language Based on Number of Individuals Served Assessments completed VP Milestones completed Average wage at closure % % % %
Transcript of Contracts Evaluation Form · Extended Services for Transition; CE Employment Outcome CE Job...
Contractor Name: Dates from: Dates to:
mm/dd/yyyy mm/dd/yyyy
SE SE HC ER JP ESS JOBS Total Combined Revenue
Revised 04/03/2020 ESS-A-010
Felony Conviction
Deaf / Blind
Contracts Evaluation FormER, ESS, JP, JOBS & SE Contracts
Page 1 of 2
Placements completed
4 week Milestones completed
Total Combined Revenue from page 1 and 2:
ESS training services completed
EM Milestones completed
Stabilization Milestones completed
8 week Milestones completed
Total Revenue Claimed for each contract:
Incentives claimed based on: Assessment to placement percentageAverage hours worked per week at closure
Legally Blind
HIV / AIDSSED
Hourly Wage
Deaf, primary communication sign language
Based on Number of Individuals Served
Assessments completed
VP Milestones completed
Average wage at closure
% % % %
Contractor Name: Dates from: Dates to:
mm/dd/yyyy mm/dd/yyyy
Individuals Served w/CE
onlyIndividuals
Served on TWP
Individuals Served w/CE &
SE
Individuals Served w/CE &
ER Average WageRevenue Received per
Service
Revised 04/03/2020 ESS-A-010Page 2 of 2
SED
Hourly Wage
Felony Conviction
Total Combined CE Revenue
Deaf / Blind
HIV / AIDS
2nd Placement
3rd Placement
Deaf, primary communication sign language
4th Placement
Incentives claimed based on:
Legally Blind
CE Maintenance
Extended Services for Transition
CE Employment Outcome
CE Job Coaching I
CE Job Coaching II
Onsite Supports & Training
CE Team Meeting
CE Visual Résumé
CE Job Development
CE Discovery and Profile
Career Exploration
Internship
Total CE Revenue:
Contract Evaluation FormCustomized Employment
Customized Employment ServicesAverage Hours per Week
Individuals Total
Served
