Laserfiche WebLink
W3lu; <br />Division of Vocational Rehabilitation (DVR) <br />Exhibit E: <br />School-to-Work Bil I i ng Checklist <br />Total Billing <br />lnstructions: <br />1. The Student Guide is sent monthly to the Student's Team, including the DVR Counselor' <br />2. The Contractor checks the appropriate box(es) as the corresponding activities are completed in <br />the Student Guide (one form per student). <br />3. The Contractor submits this completed form to the assigned DVR Counselor. <br />4. The DVR Counselor confirms information from monthly submissions of the Student Guide, <br />verifies activities were completed, then signs and dates the checklist' <br />5. The DVR Counselor submits for payment. <br />Notables: <br />The Student Guide serves as documentation for proof of completion for the payment / activity <br />point. <br />The Contractor submits no less than three (3) separate checklists to the assigned DVR <br />Counselor for each student (submitting all payment points separately is also an option)' <br />Any questions, please contact the School-to-Work Team at <br />a <br />a <br />1 :'r,r p; :::i; i i;i..; I i-'1rl.:'ijil i i.i(,|,j,::j 1, t.'* y).. :,it,i ;i . <br />Exhibit E: School-to-Work Billing Checklist <br />DSHS 11-1esA (O4t2026) <br />Month and YearContractor <br />Date of SignatureSignature <br />Student lnitialsAFP Number <br />To be filled out bY DVR Staff OnlY: <br />DVR staff sign and date below to confirm <br />received and to authorize PaYmentitems <br />Amount <br />BilledActivity Billed <br />$ 2,000n tntake Meeting <br />3 000$ <br />000$1 <br />f, Assessment <br />X .tob Seeker Tools <br />2 0 00$[ ;on offer <br />f Employment Verification $ 1,000 <br />$ 5,000f Stabilization <br />$