ࡱ> '` gbjbj{P{P G::>Z4 111823\:Z n4R9:999g:2<D=)Y+Y+Y+Y+Y+Y+Y$Z[h]lOY>g:g:>>OY99YCCC>(99)YC>)YCCRS9b4 Sh1>ST Z0:ZS:.^U?.^,S.^SC>>>OYOYC>>>:Z>>>>11$  (To be Completed By LEA) INDIVIDUAL SERVICE AGREEMENT  ISA UNDER THE SONOMA COUNTY SPECIAL EDUCATION 2010/2011 MASTER CONTRACT FOR NONPUBLIC, NONSECTARIAN SCHOOL/AGENCY SERVICES Name of Local Education Agency:  FORMTEXT       Name of Nonpublic School: Association of Behavior Consultants, Inc. Pupil s Name: FORMTEXT       SEX:  FORMCHECKBOX M  FORMCHECKBOX F (Last), (First), (Middle) Pupil s I.D./S.S. #:  FORMTEXT       Birthdate:  FORMTEXT       Grade:  FORMTEXT       Residential Setting:  FORMCHECKBOX HOME  FORMCHECKBOX FOSTER  FORMCHECKBOX LCI Foster/LCI Phone:  FORMTEXT       Pupil s Address:  FORMTEXT       LCI/Foster Home License Number:  FORMTEXT       Parent/Guardian s Name:  FORMTEXT       Phone: home  FORMTEXT       work  FORMTEXT       NON-EDUCATIONAL PLACING AGENCY: (If applicable)  FORMTEXT       All terms and conditions of the current Sonoma County Special Education Local Planning Area Master Contract for Nonpublic, Nonsectarian School/Agency Service (NPS/NPA), hereinafter referred to as the  Contract, are incorporated herein by this reference. Contractor will implement the pupils Individualized Education Program (IEP) in accordance with this ISA and the Contract. Invoices shall be submitted based on actual service provided and attendance standards in the Contract. A. BASIC EDUCATION PROGRAM (Applies to Nonpublic schools only) Contractor shall enroll pupil in its Basic Education Program commencing on  FORMTEXT      , and ending on  FORMTEXT      , unless earlier terminated by notice from LEA upon pupil s change of residence, change of placement or termination of the Master Contract. Number of Regular School Days  FORMTEXT     Per Diem Rate  = Total Regular School Year Basic Education Costs (Adjusted annually) N/A Number of ESY Days  FORMTEXT   Per Diem Rate  = Total ESY Basic Education Costs (Adjusted annually) N/APartial Day Student Number of Regular School Days  FORMTEXT    Per Minute Rate Number of minutes per day = Partial Day Student Total Regular School Year Basic Education Costs (Adjusted Annually)N/APartial Day Student Number of ESY Days  FORMTEXT   Per Minute Rate Number of minutes per day = Partial Day Student Total ESY Basic Education Costs (Adjusted Annually)N/ATotal Instructional Days (Item-D page 2) FORMTEXT  =b1+b2+b3+b4 00Total Basic Education Costs -Adjusted annually (Item -A on page 2)N/A INDIVIDUAL PUPIL SPECIFICATIONS (Complete # 2, #5, #6 and #7 or reference IEP) The pupils teacher/service provider will hold the appropriate credential/license to provide such service as issued by California Commission on Teacher Credentialing, Sonoma County Office of Education or the appropriate California Licensing Agency. The class size for the pupil will not exceed 12, or if fewer than 12, specify:  FORMTEXT      . The Related Service therapist/pupil ratio will not exceed  FORMTEXT      . The length and content of the Basic Education Program will be consistent with the Contract unless otherwise specified in the IEP. Contractor shall provide authorized services in accordance with the pupils IEP & this ISA. Method for complying with statewide standardized assessment requirements:  FORMTEXT 24nzf h  h t ĶϫϫϚybUJhi5CJOJQJh9_ 5>*CJOJQJ,jhi5>*CJOJQJUmHnHu'jhi5>*CJOJQJUhi5>*CJOJQJ!jhi5>*CJOJQJUha7I5CJOJQJh#uhi5CJOJQJh#;5CJOJQJhi5CJOJQJhi>*CJOJQJhi5OJQJhiOJQJhiCJOJQJ4z h j v  {qg[  8 $ $ $@&a$ $ $@&a$  8 $@&$ ) 8 xHX (#$dh@&a$$ ) 8 xHX (#$a$gd#;$ ) 8 xHX (#$a$gdi$ ) 8 xHX (#$@&a$(gg      ڹxnaJ-jhPhi5>*CJOJQJUhi5>*CJOJQJhiCJOJQJ'j`hhiCJOJQJU'jhhiCJOJQJUjhiCJOJQJUhi5CJOJQJhiCJOJQJ,jhi5>*CJOJQJUmHnHu!jhi5>*CJOJQJU'jvhi5>*CJOJQJU l v L  ~wmR$ ) 8 xHX (#$a$ $ $$a$ $@&$ # 8 xH$dha$ # 8 xH$@&$ 8 xH$dha$$ & 8 xHX $dha$$ ) 8 xHX (#$a$      & ( 6 D F Z \ ^ h j l Ͷڟ͈ڟzfzzRzz'jhhiCJOJQJU'j6hhiCJOJQJUjhiCJOJQJU-jhPhi5>*CJOJQJU,jhi5>*CJOJQJUmHnHu-jJhPhi5>*CJOJQJUhi5>*CJOJQJ!jhi5>*CJOJQJUhi5CJOJQJhiCJOJQJ    L N b d f p r t prɸ}i}^^ɸG-j~hPhi5>*CJOJQJUhi>*CJOJQJ'jhi5>*CJOJQJU,jhi5>*CJOJQJUmHnHu-jhPhi5>*CJOJQJUhi5>*CJOJQJ!jhi5>*CJOJQJUhi5CJOJQJjhiCJOJQJU'jhhiCJOJQJUhiCJOJQJ $&:<>HJLVZdfz|~$——i^—hi5CJOJQJ-jhPhi5>*CJOJQJU-jjhPhi5>*CJOJQJUhiCJOJQJ'jhi5>*CJOJQJUhi5>*CJOJQJhiCJOJQJhi5CJOJQJ,jhi5>*CJOJQJUmHnHu!jhi5>*CJOJQJU#$&:<>HJL  %&IJvkZM9Z'jhi5>*CJOJQJUhi5>*CJOJQJ!jhi5>*CJOJQJUhi6CJOJQJhi56CJOJQJhi5CJOJQJhiB*CJphh8p+CJOJQJhiCJOJQJhiCJOJQJ,jhi5>*CJOJQJUmHnHu'jVhi5>*CJOJQJUhi5>*CJOJQJ!jhi5>*CJOJQJU Jj|~t+$ ) 8 xHX (#$$Ifa$gd l ($ ) 8 xHX (#$$Ifa$l $ ) 8 xHX (#$a$$ )  xHX (#$a$   ,.BDFPRjòzpdTH2T+jhG1h 5B*CJUphh 5B*CJphjh 5B*CJUphhi5B*CJphhiB*CJph,jhi5>*CJOJQJUmHnHu'jBhi5>*CJOJQJUhi5>*CJOJQJ!jhi5>*CJOJQJUhiCJOJQJhi>*CJOJQJ!jhi5>*CJOJQJU,jhi5>*CJOJQJUmHnHu|~bdjlnĺĚ{ڤĚĚo\%jv h 5B*CJUphhG15B*CJph%j h 5B*CJUph hiCJ h9_ CJhiB*CJphhi5B*CJphhG1B*CJphhiB*CJphhiB*CJphh 5B*CJphjh 5B*CJUph*jh 5B*CJUmHnHphu$~0kd" $$Iflֈ~ X %*F04 lal$@&Ifl bdl$@&Ifl ($ ) 8 xHX (#$$Ifa$l  lnA($ ) 8 xHX (#$$Ifa$l kd $$Iflֈ~ X %*F04 lalPRT($ ) 8 xHX (#$$Ifa$l  PRT`bdxz|:=>?ŻϊϊwdŻϊ%j h 5B*CJUphh 5B*CJph h9_ 5CJhiB*CJphhG1hiB*CJaJphhi5B*CJphhG15B*CJphhG1B*CJphhiB*CJphhiB*CJph*jh 5B*CJUmHnHphujh 5B*CJUph#kd $$Iflִ~ X %***~ F0    4 lalytG1`b:>($ ) 8 xHX (#$$Ifa$l  >?kdi $$Iflִ~ X %***~ F0    4 lalytG1?WYhijtu $%կեujuju`hCJOJQJh &56OJQJhi56OJQJhiOJQJ hiCJ h9_ CJ hi6hi5B*CJphhiB*CJph"j|hG1h 5CJUh 5CJmHnHu h 5CJjh 5CJU hi5hihiB*CJphhi5B*CJph"?Yi$@&Ifl ($ ) 8 xHX (#$$Ifa$l $$@&Ifa$l % ) 8 xHX (#$$Ifl %>b`T33!$ & F )  xHX (#$a$gd $ & F`a$kd$$Iflu\~ X %~ 0F04 lalyt9_ z|̵ٞ̑p`Ip/p2jhPfDh5>*CJOJQJUmHnHu-jUhPfDh5>*CJOJQJUhPfDh5>*CJOJQJ'jhPfDh5>*CJOJQJUhPfDhCJOJQJhQMphCJOJQJ,jh5>*CJOJQJUmHnHu-jh8h5>*CJOJQJUh5>*CJOJQJ!jh5>*CJOJQJUhCJOJQJh>*CJOJQJ T T T6TJTTTTTTTTTTTTT϶Ϝ{q`Sh5>*CJOJQJ!jh5>*CJOJQJUhCJOJQJhCJOJQJ-jAhPfDh5>*CJOJQJU2jhPfDh5>*CJOJQJUmHnHuU-jhPfDh5>*CJOJQJU'jhPfDh5>*CJOJQJUhPfDhCJOJQJhPfDh5>*CJOJQJUTT UUUUUiii*$ )  xHX (#$2$Ifa$l $ ) * xHX (#$a$ & F $gd & F , xHJX (#$gd!$ & F )  xHX (#$a$gd       Dates student will not attend NPS per SELPA approved calendar:  FORMTEXT      . Other Provisions:  FORMTEXT      . C. DESIGNATED INSTRUCTION AND SERVICES/RELATED SERVICES: ESTIMATE Pupil s Name Pupil s Name: Service Provided Cost Per Hour as set forth in Master Contract  Estimated Hours, Miles or Sessions until next IEP ESTIMATED TOTAL (Equals Cost Per Hour times (x) Estimated Sessions times (x) Hours per session) FORMTEXT       FORMTEXT       Eligibility  FORMTEXT       MinutesFrequency (times per week/ month/ Year)WK/ Month/ YearStart Date1. Behavior Modification Specialist FORMTEXT       FORMTEXT    FORMDROPDOWN  FORMTEXT       FORMTEXT $74.66 FORMTEXT       FORMTEXT  =f4*g4 $0.00$0.002. Temporary Support Behavior Assistant FORMTEXT       FORMTEXT    FORMDROPDOWN  FORMTEXT       FORMTEXT $28.51 FORMTEXT       FORMTEXT  =f5*g5 $28.62$28.623.  FORMTEXT       FORMTEXT       FORMTEXT    FORMDROPDOWN  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT  =f6*g6 0$0.00*Maximum DIS and Related Services Cost Estimate(C)Above Estimated Totals  FORMTEXT  =h4+h5+h6 $28.62$28.62*Maximum Total Basic Education Cost Estimate(A) Item A from page 1  FORMTEXT      *Maximum Total Basic Education and DIS/Related Services Cost Estimate(A + C)  FORMTEXT  =d7+d8 $28.62$28.62Estimated Per Diem  DIS/Related Services divided by instructional daysInstructional Days - Item D from page 1  FORMTEXT     (A + C divided by D)  FORMTEXT  =c9/c10 !Zero Divide     The parties hereto agree to comply with the terms of the Master Contract and hereby execute this ISA by and through their duly authorized agents or representatives. Contractor - Nonpublic School or AgencyLocal Educational AgencyAssociation of Behavior Consultants, Inc.  FORMTEXT      ________________________________________________________________________(Authorized Signature) (Date)(Authorized Signature) (Date)3808 Zieber Rd(Name)  FORMTEXT      Santa Rosa, CA 95404 FORMTEXT      (707) 575-3290 Phone FORMTEXT      (415) 276-4536 Fax(Mailing Address) FORMTEXT       Phone  FORMTEXT       Fax     PAGE 2 10/11 2010/2011 ABC ISA Page  PAGE 2 of  NUMPAGES 2 TTTUUU UUUUVXVZV\VVVVVWW׳}reZ}rM}@2hi56:CJOJQJhi6:CJOJQJhi56CJOJQJhi5CJOJQJhi5:CJOJQJhi:CJOJQJhi5:CJOJQJhi5:CJOJQJhi5CJOJQJ hi5CJhCJOJQJh5>*CJOJQJ,jh5>*CJOJQJUmHnHu!jh5>*CJOJQJU-jhh5>*CJOJQJUUUUUFVXVZV\VpVVV\% )  xHX (#$$Ifl ($ )  xHX (#$$Ifa$l ($ )  xHX (#$$Ifa$l *$ )  xHX (#$2$Ifa$l  VVVWWMkd-$$Ifl4,r;J$``<`FF$4 la*$ )  xHX (#$2$Ifa$l WWWWWWWWWWWWWWWWWWWWWWWXXXݨ}sesTe!j]hiCJOJQJUjhiCJOJQJUhiCJOJQJ$jhi5CJOJQJUhi5CJOJQJhi5:CJOJQJhi5:CJOJQJ)jhi5CJOJQJUmHnHu$jHhi5CJOJQJUhi5CJOJQJjhi5CJOJQJU hi5CJWWWWWW]2*$ )  xHX (#$2$Ifa$l % )  xHX (#$$Ifl ($ )  xHX (#$$Ifa$l *$ )  xHX (#$2$Ifa$l ' )  xHX (#$2$Ifl 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