HomeMy WebLinkAboutFully Executed Agreement (2)DSHS Agreem ent Number
2663-70974COUNTY PROGRAM AGREEMENT
School-to-Work Direct Service Pilot
Contract
V,/ it s h i,t../ I o I S l; { rl
Department of Social
& Health Services
Transforming lives
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Administration or Division
Agreement Number
County Agreement Number
DSHS corutnnct
8500cc-631225
IVISION
Division of Vocational
Rehabilitation
NISTRA
Division of Vocational
Rehabilitation RESS
4565 7th Ave SE
wA 98503
Austin Diaz-Munoz
Contracts Specialist
NAMEc
DSHS
Austin.DiazMu dshs.wa.
I tetr,, Lit,r,'1;1 1,..,1'1.
FAXDSHS
( : lr:-.lr
ETELEPH
564 200-2812
Kittitas CountY Court House
205 W Fifth St Room 211
NTY ADDRESS
Ellens wA 98926
Kittitas CountY
NAME
NAME
Kasey Knutson
COUNTY CPLOYER IDE TION
NUMBER
co
.kittitas.wa.usknutsonka962-5883
NTYTELEP
509 962-7090
COUNTY CO
ASSIST
AGREEMENT?
No
OSES OF PROGAIS
Fee For Service
RAM MENTMAXIMO DATE
a913012027
PROGRAMSTART DATE
0510112026
AGRE
County Program Agreement by reference:
X exnitits (specify): Exhibit A - Data Security Requirement.s Exhibit B ' Student Guide lnstructions' Exhibit C '
Student Guide, Exhibit D - School-to-WorX Stu'dent bata, Exhibit E 'School-to-Work Billing Ghecklist
No Exhibits
and are incorPorated into thisExhibits are attachedWhen the box below is marked wilh an X, the followingEXHIBITS
DSHSonsnature
USIVCntireendtheoffinentational,ndarenration represthofSContractntegcoandonsndititermThes oralunicationscommndmentswritingreemdtnagersedanprevroustheergortiesbetweensupingderstandpaunngandreadhavethatnbeowheyTherepresentContract.sig ingofmatterpartiesthithorS€,otherwi ng subjeciregardi ndibi on DSHSbe onlyshallTlshngontractCCothisntract.executetotheauthorityhaveandContractthisunderstand
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DSHS Central Contract Services
6017CF County Program Agreemenl (10-31-2017)
Page 1
Special Terms and Conditions
1. Definitions
b
a ,,AuthorizationforPurchase(AFP)"me?.nstheformalDVRfiscaldocumentthatotficiatlyidentifies
,na-urtfiorites a DVR Contractoi to deliver a specific service'
''CRP"or"CommunityRehabilitationProgram"'meansaproviderwnig'n'qror1lO=l:'t'fllon"l
rehabilitation service to'inoirJu"rs with disabiliG;i; un"nl" those individuals to maximize their
opportunities for emPloYment'
c, "Contractor" means Kittitas County
d. ,,county" means the political subdivision of the state of washington' named. above' performing
services pursuant to this Program ng,u*;t"nianJ inAua"s the"County's officers' employees' and
authorized agents.
.,CountyCoordinator',meanstheofficialdevelopmentaldisabilitiesprogramcoordinatorortheir
designee.
.DDCS" means the Developmental Disabilities community services' formerly known as the
J."J"pt"nial Disabilities Admin istration (DDA)'
,,DVR'meansDepartmentofsocialandHealthservices'DivisionofVocationalRehabilitation'
..DVRCounselor(s),,meanstheVocationalRehabilitationCounselor(s)assignedtotheSchool-to-
Work Student through the DVR eligibility process'
,,lndividual Plan for Employment (lPE)" means a DVR form that documents important decisions
about vocationat renafiitution services tol. "'6trount
as defined in wAC 388-891-1 1 15' The
decisions documenteJon if"'" IPE include' but are not limited to:
(1) The employment outcome the Student plans to achieve;
(2) Each major step needed to accomplish the employment outcome;
(3)TheStudent,sresponsibilitiesinaccomplishingeachstepoftheplan;
(4) DVR,s responsibilities in assisting the Studentto accomplish each step of the plan;
(5)VocationalRehabilitation(VR)servicesneededtocompleteeachstep;and
(6)TermsandconditionsthestudentandtheDVRCounseloragreearerequiredfor
continued suPPort from DVR'
,,lntensive Training services" rneans individualized, one-on-one job skills training and support
provided at tne suppoit"A **pf"Vment job site to enable a Student to:
(1)AttainJobStabilizationinon-the-jobperformance,withjobsupports;
(2) Meet the employer's expected level of work productivity; and
(3)TransitiontoLong-TermServiceswhenstabilizationisachieved.
,,JobFoundation"-TheJobFoundationprocessisintendedtoengagestudentsearlierintargeted
f
g
h
k
DSHS Cenlral Contract Services
o'di i6 i c"r.tv Program Agreement (1 0-3'1 -20"1 7)
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SPecial Terms and Conditions
employment planning and connection; increase partnerships with school staff to complete siudent's
Job Foundation report with actionable next;;;;;Jil.rbr"" the number of students completing
transition programs with a job or secondary education connection'
(1)TheJobFoundationreportandprocessmaybe,asourceofinformationforthe
AssessmentindetermininganemploymentgoalfortheStudent.
,,Job Placement" means locating, securing, and placrng-a student into competitive rntegrated
emptoyment that is t;[;1ry ;g;;eO upo,ini'i;JDtR"C;unselor, the Contractor' and the Student
or the Student's Team.
,,Job stabilization" means the student, the ernployer,llte DVR Co.unselor and the contractor
mutually agree that " siuo*nt placed in . sup[oti"o i*ptovment position has demonstrated and
maintained satisfactory on-the-job performance and has the quantity and type of long-term
employment supports available to ihem thai are needed to maintain satisfactory on-the-job
performance.
,,Long Term Services" means ongoing support services provided by an entity other than DVR afier
the Student obtains "rpio'm"nt"andlxits
DVR Schoo l-to-Work services.
,,Monthly Progress Report" means progress reports that are to be filled out on a monthly basis and
shared with the Student's Team to Oumon"tiatl-piogt"tt towards employment and summarize
n'rontf.rly work being done with and on behalf of the Student'
m
n.
o
p. "Assessment" means
q
I
S
(1) ldentify a Student,s unique work interests, abilities, and any competitive employment
barriers related to communicrti;;' ;"bii'ty, work skitls woik tolerance, self-direction
lcognition anoluurningl, "no
inGi'puttoni'attituOes, skills' behavior' or self-care' etc';
and
(2)ldentifythenatureandextentofsupport(s)andaccommodationsneededforthe
Studenttoobtainandmaintaincompetitiveintegratedemployment.
,,school-to-work" means a program that supports a seamless transition for students with
intellectual/developmentaldisabilities trorn "inoof
to adulthood through employment services and
lonnecting students to the necessary resources for success'
,,service Delivery outcome plan (sDop)" is a written plan jointly developed by the student' DVR'
DVR Counselor, and cRp representative r"r "oiri.i"si
school-to-work services' The details of the
agreement are tailoreJ to the unique needs of the student and documented'
.,student,,meansanindividualwithanintellectual/developmentaldisabilityage20to22whoisin
their high school transition program'
..StudentGuide,,meansaguidedesignedforaStudentand/orparent(s)lguardianstohouseSchool.
to-Work related documentation, informati";';;;;;m"nts, activity logs' and notes' This guide is a
student,s ,roadmap'to ensure key activities and milestones are completed and organized'
,,student,s Team" means any combination of people, including,but not limited to; educators' cRPs'
the Student's Legal Representative or curiiil.lbo'nt' St'tt-' DVR Counselor(s) who support a
Student as they *ouulo*"'ds Job Placement and Job Stabilization'
U
DSHS Cenlral Contract Services
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2.
SPecial Terms and Conditions
v. ,,subcontractor,, means a Community Rehabilitation Program that the Contractor has separately
chosen to perform all or a portion of the iuties and obtigations that the Contractor is obligated to
pedorm pursuant to this Contract.
w, .youth Extended services" means ongoing support services and other appropriate services
provided to support a Student witn a mosi"srg;iiicunt disability in employment as a means to bridge
employmentsupportbetweenstabilizationandlong-termservices.
purpose. The purpose of this Contract is to represent a collaborative effort between community,
educators, caregivers and providers to supporiStudents with comprehensive training and experience
that will lead to paid, integrated employment by graduation'
period of performance. The period of performance for this Contract shall begin May 1, 2026 and end
September 30, zo27. Contractor will deiermine their specific program timeline within the period of
performance.
General Requiremenis. The contractor must perform the minimum expectations below in conducting
the services of this Contract:
a, Provide all services of this Contract in a manner and setting(s) that meet the requirements of
Washington State DSHS Administrative Policy 7'02'
b. Arrange and be responsible for all costs associated with communication interpreter services' as
needed, to provide disability-related access per the Ame-ricans with Disabilities Act (ADA) unless
the cost involved would cause an undue hardship (significant difficulty or expense) for the
contractor. Determination of what constitutes an undue hardship will be made on a case-by-case
basis, relative to the Contractor's overall resources
(i) lf an undue hardship does exist, the DVR Schoolto-Work/Transition Program Manager
or their designated t"pr"""nt"tte may authorize paying for interpreter services and/or
translation slrvices apart from the contracted fee for service.
(2) provide and be responsible for the cost of providing services through alternative
formais, methods, anO languag"., ", need'ed, for Students who have Limiied English
Proficiency (LEP) as per the Civil Rights Act of 1964'
c. contractor is responsible for addressing culiural, language, and technological accessibility for all
students to the best of their abilities wh-en performing tne services under this contract'
d. Eligibili$: Students must meet the following criteria:
(1) DDCS-eligible.
(2) DVR-eligible.
(3) Enrolled in a school district educational program that may include, but is not limited to:
3.
4.
(a) High school;
(b) Home school;
(c)Technical college, by exception approved by the DVR Transition Program Manager or
designated rePresentative;
DSHS Central Contract Services
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Special Terms and Conditions
(4)HigherEducation'bvexceptionaOprgvgdbythe'DVRJt:l"lti:'l'ProsramManageror
designated representftu"-siuo"lri starts sfhool-to-work services as of May 1' 2026 or
latef as determined by the Student'
(a) Schoolto-Work is a wrap-around service that,s only available one (1)time per Student.
i.studentswhochoosetoparticipateinthiscohortmgvno|paficipateagainundera
different contract covering a different cohort. snoulO ine siuOent change their mind on
the cohort they choose to participate in, the contractor is responsible for communicating
*itn-OVn to ensure there are no duplicate payments'
ii.Slrr:ulclaStudentmovefromoneSchool-to.WorkCountytoanother,orpauseservices,
due to individual .ir.un1.irnres, it is determined by the DVR Transition Program
Manager or designatej t"pi"t"ittttive, whether School-to-Work services will continue'
and if!o, at one point in the process'
(b)StudentsmustapplyforDVRtostartSchool-to-WorkservicesnolaterthanJanuary3l,
2027. Students who intenO io rlJ-'"'uitus attei-tanuary 31 may only do so w1h prior
written approval trom tne ovn school-to-work iransition Program Manager or their
designated rePresentative'
(')fl",'ff ::;ft?T;3:-:,1iff :F#,nl;nT:'.J$"J91?i:?,:f, ;'"JT;?in'F,l?"*
Manager or designated representative'
(6) Have an lndividualized Education Plan (lEP)'
,',1.J:3["',;3,X?I*:::i5,5:J:::T3L"JS*ii5]#+i,?ri;]:[:I'"""ji,rrli!
achieved. This requirement must ue compieteJ ov tnu 6nu of the schoolto-work lntake
"^J
n"t*."ment Phase per section 5' Statement of Work'
e.MeetingsmustbeheldintheformatbestsuitedfortheStudent'lfallpartiesarenotabletoattend
meetings in person, use of t"l"pnon" oivideo conferences is encouraged to complete the process
in a timelY manner'
f. contractor must keep all students enrolled in school-to-work through the duration of this contract'
regardless li "rt""r" and/or si"iiriirli"n, unless stuaent chooses-to exit the program of their own
volition or due to unforeseeable circumstances'
, " :l ;,gfl ; :'8ff :f ili,in[ $i:lffiffi I i,33 t'j.".13 I T 5:ffi ::s?s l::,iffi:T ""' "
instruction.
g. service Delivery Agreement: The contractor's delivery of VR t?ryi:"i specified in this agreement
will begin ,ptn in"l"mpletion and signing of the agreed upon SDOP'
h. service Delivery Payment: The contractorwill be paid upon completion and submission of the
required Oocumentaiion demoni;il; ;diuUoti ot LrLh of the'three phases for each Student as
ouilined in Section 5, Statement of Work'
i.ServiceDeliveryMethod:ThisContractutilizesExhibitC-studentGuideasareportingtoolandall
associated activities ouilined i, s""iil" 5, statement otwoilisrrall be carried out using the student
Guide. Exhibit B - student cuioelnsiiu"tion. orers instiu"tion on how the contractor may use the
DSHS Central contract services Page 5
o'O"izC i Cornty Program Agreement (1 0-3 1 -20 1 7)
SPecial Terms and Conditions
Student Guide'
5. statement of work. The contractor shall provide a program to provide the services, staff, resources'
and otherwise do all things n"."rury foi, br incioeniat t-o tfre performance of work, as set forth below:
Servicesshallbesortedintothefollowingthreephases:
lntake and Assessment Phase'
Job Placement Phase.
EmPloYmertl Phase.
a. lntake and Assessment phase. The intent of this phase is to ensure the Student and the Student's
Team collaborate to determine ii"norgh information is available to establish an employment goal'
establish the employment goal, ano nu'ilc an individualized roadmap of the student's transition from
their education to meaningfut community employment. This shall be accomplished lhrough the
following objectives:
(1) lntake
(a) At a minimum, the contractor shallwork with the student, the student's legal representative
o,. grrrJirn (unless they are their own), the cRP, and the DVR Counselor to:
i.Completeintakeformsasneeded'includingtheSDoP'
ii. Ouiline how assessment will occur, including additional meeting time'
(b)Theemploymentgoalisestablishedanddocumented.
i. Determine what Job Seeker Tools are needed for the Student's employment goal'
(2) Assessment
(a) Through the assessment process, the Contractor will collect information about the Student's
strengths, skills, and rrpjort. needed for success on the job. This .information will be based
on the Student,s schoot,-irome, and community work-re-lafed activities, interviews-with the
Student, family, school personnel, and others who are familiar with the Student' This
information may be outalneJ from Job Foundation report, work-based learning, school
ssessments, etc'
(b)Aiaminimum,thefollowingcriteriamustbeaddressed:
i. History of school attendance and reliability;
ii' Behavior support or potential strategies;
iii. Student Communication skills;
iv. Student learning Preferences;
v. Student's Personal hYgiene;
vi. Potentialjob safetY concerns;
DSHS Central Contracl Services Page 6
601 7CF County Program Agreement (10'31-2017)
Special Terms and Conditions
vii, Student stamina/endurance;
viii. Student social skills;
ix. Demonstrated skills and task performance;
x. TransPortation needs; and
xi. Work preferences and interests'
(c) Based on the above criteria, the Contractor must determine recommendations regarding
appropriate ancJ attainable job goal(s) that align with the student's:
i. Skills and interests;
ii. Desired work environment;
iii. Desired schedule;
iv. Ability to travel tolfrom work within a reasonable length of time; and
v. Accommodations and supports necessary to achieve identified goals.
b. Job placement phase. The intent of this phase is to provide the Student with the tools they will
need to find and secure meaningful community employment based on their employment goal. The
Contractor shall provide all services necessary to locate, secure, and place a Student into
competitive integrated employment that is muiually agreed uqon .by the Student's Team' Specific
placement expeltations shall'be outlined on the DVR SDOP for Job Placement and lntensive
Training.
placements less than 10 hours: Job placement goals that are less than 10 hours per week shall be
approved in advance by the appropriate DVR Vocational Rehabilitation Counselor in consultation
with the Student's Team.
(1) Job Seeker Tools
(a) Contractor shall create tools based on individual need, such as a resume' cover letter,
videos, PowerPoint (or comparable applications), and/or portfolios'
(b) Contractor may also develop other materials as it pertains to the Student's individualized
pathway to emiloyment such as a letter of recommendation, create and/or update Linkedln
page or other social media, etc.
(2) Job Offer
(a) lf the Student received the job offer, Contractor must provide details of the job offer including
the following:
i. The Student's EmPloYment Goal;
ii. Job Title;
iii. Start Date;
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6017CF County Program Agreement (10-31-2017)Page 7
Special Terms and Conditions
iv. Job Duties;
v, ExPected WeeklY Hours;
vi. Starting Wage;
vii. Location;
viii. Transportation Consideration;
ix. Benefits Package; and
x'PotentialTrainingservicesandDate/Additionallnfo.
(b) lf the student rejected the job offer, contractor must provide the reason(s) why the student
rejected tne joo oter. oetails must include how the job did not meet their individualized
employment goal, as well as the criteria in (2)(a)'
(c) lf a student has a job goal that is 10 hours or more per week, but receives a job offer fewer
than 10 hours per w*ui, tf,u Contractor shall request approvalfrom the DVR Counselor in
consultation with the student's Team should the student want to accept the offer'
Employment Phase. The intent of this phase is to verify, stabilize, and maintain meaningful
community emPloYment.
(1 ) EmploYment Verification
(a) Contractor shall submit the following method of verification of employment after Student's
first daY of emPloYment:
i. The Employment Verification page of the Student Guide'
(2) lntensive Training Services
(a) lntensive job training expectations shall be outlined by the Student's Team' The Contractor
shall provide individialized, one-on-one job skills training and support at the supported
employment job site that will enable a Student to:
i. Achieve job stabilization in on-the-job performance, with job supports and services' and
a fading Plan;
ii, Meet the employer's expected level of work productivity; and
iii. Transition to Youth Extended services as needed and Long-Term Services'
(3) Stabilization
(a) stabilization is achieved when the student's Team and their employer agree that the
student has demonstrated and maintained satisfactory on-the-job performance and has
long-term suPPorts in Place.
(b) Job stabilization is determined for each Student in supported employment based on their
unique circumstances. The DVR Counselor determines that the Student's work performance
is stabilized *lin input ttot tn" Student, employer and extended service provider when:
DSHS Central Contract Services
6017CF County Program Agreemenl (10-31-2017)Page 8
Special Terms and Conditions
i. The student has reached the agreed-upon goal for.the.number of weekly hours worked'
unless the Student and the DVR CounTJl'igt"" that the job represents substantial and
suitable emPloYment'
ii. The student has reached a maximum level of on-the-job employment and meets
emPloYer exPectations'
iii. The supports available are adequate for the student to maintain stable employment and
t""ttnd "mployur;s
expected level of work productivity'
iv. The student has long-term employment supports available or in process and is able to
transition tu these sJrvices to maintain job stability'
(c)onceachieved,aStabilizationReportandsupports^lnthgjobtheStudentmayneed,must
becompleteotortnestudentasoutlinedinthesDoPandmustinclude:
i. Detail and summary of how the placement hours were met (or if the job represents
suitable employment); and
ii. Detail, descriptions, and summary of how the DVR Counselor, CRP, and the employer
;g;;; tnat ftre emptoyers expeciation have been met; and
iii. Detail and summary of how long-term supports have been set up and will occur; and
iv. The strengths the Student brings to the job' and
V.TheStudent,sfadingplan,includinghowtheywillremainstableontheiob;and
vi. Additionaltraining, services, and supports the Student may need'
(4)StabilizationneedstobeachievedbySeptember30,2o2T.However'exceptionsmay
be made on a case-by-case nasis tliough tne_ena of the calendar year (December 31'
2027) withapprovat from the DVR i;;;ii"; Pl.ogr"r Manager or their designated
representative. Youth Extended Services'
(a) DVR shall provide Youth Extended services needed by the student until DDCS funds are
available, in accordance with WAC 388-891A-1060'
i. should youth Extended services reach six (6) months, the contractor and DVR shall
collaborate to determine next steps *ni"f'., ni"l include additional Youth Extended
Services or other options as needed'
(b) Youth Extended services funded by DVR shall be outlined on the DVR Youth Extended
Services SDOP'
i. Maximum 26 hours per month at the hourly rate of $105'00
(A) lf more than 26 hours per month are needed for a Student, the DVR Counselor must
documenttherequirementformoreservicehoursandstaffthecasewiththeir
supervisor io request an exception to this maximum'
(B)Exceptionsmaybemadeonacase-by.casebasisandmustbereportedtotheDVR
school-to-work Transition ptogr;* Manager or designated representaiive'
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6.
SPecial Terms and Conditions
Deliverables. The Contractor shall demonstrate completion of .activities for payment through the
following reporting ."inoOr. Submissions should be written in language that directly.addresses the
student and shall continue for g0 days beyond the student's stabiiization, or until DVR-case closure'
The Contractor shall submit the required fvfonini' Progress n.".pol to the assigned DVR Vocational
Rehabilitation counselor for each student who is served by this contract.
a. Student Guide
(1) The Contractor shall submit a copy of the Student Guide to the Student's Team at the
end of each month demonstratinbin" progress of the Student's transition year via
completion of the Monthfy eiogre:ss nipofts section located on the front page and the
back uf tlre Student Guide.
(2) The Contractor shall submit Exhibit E - School-to-Work Billing Checklist to the DVR
Counselor upon completion of payment points for each student as demonstrated in the
Student Guide,
(3) Contractor shall submit a minimum of three (3) Schoolto-Work Billing Checklists for all
PaYment Points for each Student'
(4) The Student Guide is a living document that comprises the following activities:
(a) lntake - signed sDoP & Roles and Responsibilities of the student's Team'
i. Roles and Responsibilities of the student's Team will include;
(A)Team member's role'
(B)Teammember,scontactinformationincludingname,email,andphone.
(C)Team member's responsibility to the Student'
(b) Assessment - comprehensive assessment demonstrating how an Employment Goal is
reached and established'
(c) Job Seeker Tools - Such as ResLlme,Cover Letter, Video, PowerPoint, Portfolio, etc
(d) Job Offer - Documentation/Details of a Job Offer as stated in Section 5 - Statement of
Work.
(e) Employment Verification - Documentation/Details of a Job Start as stated in Section 5 -
Statement of Work.
(0 stabilization - stabilization Report.as stated in section 5 - statement of work'
b. Data Sharing and Reporting - DVR is tracking the progress a.nd success of the School-to-Work
program to ensure the program is available tI att dtualnts who meet eligibility requirements across
the state. tn orouito ,J"#pfirn this, the Contractor must submit Exhibit D - School-to-Work
Student Data.
(a)ExhibitDincorporatesthefollowingrequireddataelements:
i. Number of students identified as eligible for school-to-work in county or counties
served. lf the Contractor coordinatei services for more than one county, the Contractor
DSHS Central Conlract Services
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SPecial Terms and Conditions
shall submit data for each countY'
ii. Number of Students enrolled with DVR'
iii. Number of Students emPloYed'
iv. Number of Students who exited School-to-Work early
v. Reason for Student exiting early'
7
vi. Number of students who exited school-to-woruDVR employed and transferred into
Long-1"erm Servlces with DDCS'
vii. Number of students transferred into Adult services or Job Placement with DVR'
(b) Exhibit D must be submitted a total of three (3) times to the DVR School-to-work Transition
Program Manager or their O"tlg;"iJ i**i"'nt"tive..throughout the cours e of the 2027
transition cohort following tne netow sch"our" and with the appropriate tab completed:
i'The,,Aug3l,2026,tabshallbesubmittedonAugustgl'2026,0ruponexecutionofthe
Contract, whichever is later'
ii.The"March31,2A27'tabshallbesubmittedonMarch3l'2027'
iii, The ,.Sept 30, 2027,, labshall be submitted on Septemb er 3a, 2027, or at the conclusion
of the Contractor's program' whtchever is sooner'
(c) lf the above dates fall on a state-recogntzed holiday.or weekend' contractor may submit
Exhibit D on the nearest workday prior to the due date'
Monitoring'
a. The Department of social and Health services, Division of Vocational Rehabilitation is required to
maintain a contract administration ,yrt#'*ni.n "n.rr"s
that contractors perform in accordance
with the terms, conditions, and specific"tiont of their Contracts' DVR manages and monitors its
contracts through conducied risk asseslmunt" ana monitoring plans' Authority to conduct such
reviews is provided by Title 2 of the c"i* "r
ilJeral Regulati-ons (cFR)' 34 CFR 80'36' oFM
SAAM policy 16.20 sit osns Administrative Policies No. 13,11 and 19'50'30'
b. Progress Meetings: DVR School-to-work Transition Program Manager shallwork with contractors
to plan meeiings *r,Ln "lto* discussion of program progress and support methods to ensure
students are receiving adequate =ervicus tJ ob"tain employment. ln addition, contractor may invite
DVR partnerc to utiun'olo."j countv-inliutuo *ruice piovider meetings. DVR partners may include
local DVR Counselors, supervisors, and School-to-Work staff'
8. Subcontractors
the followin g services :
(1) Community-Based Assessments; and
(2) CRP Job Placement; and
DSHS Central Contract Seruices
6'o1ic i county Program Agreement ( 1 0-3 1 -201 7)
Ail Subcontractors utirized by the contractor in derivery of direct services described in this contract
shatl hold a current DVR Community Rehabiiitati;; rrogram (cRP) contract in which they providea
Page 1 1
SPecial Terms and Conditions
(3) CRP lntensive Training Services'
b. Subcontracts
9.
('l) copies of proposed subcontracis between the contractor and subcontracted cRPs
snarr nL piwiied to ovn sctroor-to-work rransition Program Manager prior to the start
date of this agreement; OR
(2) within seven (7) calendar days of contractor signature on this agreement'
(3) All subcontracts must incorporate this Contract by reference and include all of this
Contract's requirements.
consideration. Total consideration payable to contractor for satisfactory performance of the work
under this Contract i. 6 i; ; ;ximirni ot gf +,ooo per Student. This is a comprehensive rate for each
service and takes into account the administiatlve costs associated with operating the program as well
as the actual costs of each service, and shall be based on the following:
a. lntake and Assessment Phase - A total payment of $5,000-p.er student shall be paid to the
contractor when the individual Student hai completed the following activities:
(,1) lntake Meeting: paid upon receipt of a School-to-Work Billing Checklist and a written
report in ine Student Guide. The total billable amount for this activity is $2,000 per
Student.
(2) Assessment: Paid upon receipt o|a s.9|991-to-Work Billing Checklist and a written
reportin the studeniGuide. The total billable amount for this activity is $3'000 per
Student.
b. Job Placement Phase - A total payment of $3,000 per student shall be paid to the contractor when
the individual student has completed the following activities:
(l) Job Seeker Tools: paid upon receipt of a School-to-Work Billing Checklist and a written
r"po.t in tn. Student Guide, The toial billable amount for this activity is $1,000 per
Student.
(2) Job Offer: paid upon receipt of a School-to-Work Billing Checklist and a written report in
the student Guide. The total bilr"nr" amount for this aciivity is $2,000 per student' A job
offer is payable once upon t"""ipt of the offer regardless of whether or not the Student
accePts the job offer'
(3) lf a student with a placement goal of 10 ho-urs per week or more accepts a placement
for less than 10 hours per *u"i, rn exception for payment.t.ay..b." g.ranted with
approval of the appropriate'ovi supervisor. This approval shall b-e in consultation with
the team including the StuOeni' Siudent's Family (as applicable)' DVR Counselor' CRP'
and CountY staff.
c. Employment Phase - A total payment cf $6,000 per student shall be paid to the contractor when
the individual student has completed the following activities:
(1) Emptoyment Verification: paid upon receipt of a.School-to-Work Billing Checklist and a
writteriiepoit in ttre studeniCuibe. The total billable amount for this activity is $'1'000
Per Student.
DSHS Central Conlract Services
6017CF County Program Agreement (10-31-2017)
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SPecial Terms and Conditions
(2) Job Stabilization: Paid upon receipt of.a.school-to-work Billing checklist and a written
report in the Student buiO". The total billable amount for this activity is $5'000 per
Student.
10. Billing and PaYment
successfully served by this Contract
this Contract.
c,
11. lnsurance ' Self'lnsured
a
a.
The Contractor shall submit no less than three (3) separate original school-to-Work Billing
Checklists to tne assigilJ bVC Vo""tional Reha'bilitation Counselor for each Student who is
(1) At a minimum, one School-to-Work Billing Checklist per phase as outlined in Section 5,
Statement of Work'
(2) School-to-work Billing checklists may olry!9 submitted to DVR upon the successful
completion of an activity outlined in the SDOP'
(3) Schoolto-work Billing checklists must be submitted within sixty (60) days of service(s)
having ".*""0 "|"
witnin sixty (60) days of the completion of each phase'
b. payment shall be considered timely if made by DSHS within.thirty (30) days after receipt and
acceptance by the designated DvR counslroi of the properly completed school-to-work Billing
Checklist. p.Vr"nirnait Oe sent to tfre aOJiess designaied by the Contractor on page one (1) of
DSHSmayatitssolediscretion,withholdpaymentclaimedbythecontractorforservicesrendered
if the Contractor fails to satisfactory comply *itn ,ny term or iondition of this Contract'
b
DSHS certifies that it is self-insured under the state's self-insurance liability program' as provided
by RCW 4.92.130, "nJ
tn"tt pay for losses for which it is found liable'
The contractor certifies, by checking the appropriate box below, initialing to the left of the box
selected, and signing this Agreement, that:
(1) ITheContractorisself-insuredorinsuredthroughariskpoolandshallpayforlosses
for which it is found liable; or
(2) n The Contractor maintains the types and amounts,of insurance identified below and
shall, prioi to it u "*u"rtion
of tnis'Agreement by DSHS, provide certificates of
insurancetothateffecttotheDSHScontactonpageoneofthisAgreement.
commercial General Liabilitv lnsurance (c.GL\ - to include co.verage for bodily injury' property
damage, and contracm;iliil with the tJ6wing minimum limits: Each occurrence - $1,000'000;
GeneralAggregate - $2,000,00b. The policy shaliinclude liability arising out of premises'
operations, independent contractors' products-completed operations' personal injury' advertising
injury,andliabilityassumedunderaninsuredcontract.TheStateofWashington,DSHs,itselected
andappointedofficials,agents,andemployeesshallbenamedasadditionalinsureds.
12.lnvestigations of Contractor or Related Personnel
DSHS may, without prior notice, suspend the contractor's performance of the contract if the
contractor, or any partner, officer or director of the contractor, or a subcontractor' or any employee
DSHS Central Contracl Services
Oof zcf County Program Agreement (10-31-2017)
Page 13
SPecial Terms and Conditions
or volunteer of the Contractor or a subcontractor, is investigated by DSHS or a local' county' state
or federal agency regarding any malter that, if ultimately established, could either:
(1)Resultinaconvictionforviolatingalocal,stateorfederallaw.
(2)lnthesolejudgmentofDSHs,adverselyatfe$.t-|redeliveryofservicesunderthis
contract oitn"- health, safety or welfare of DsHS students.
b. DSHS may also take other lesser action, including but not limited to, disallowing a staff member'
employee, or other individual associated with the Contractor or a subcontractor, from providing
services, or from having contact with DSHS sturients, until the investigation is concluded and a final
determination made Uylfre investigating agency if inconclusive or unsubstantiated'
Removal of lndividuals from Performing Services
a. ln the event that any of the Contractor's employees, subcontractors' or volunteers who provide
services under this Contract do not meet qJalitications required by this Contract or do not perform
the services as required in this contract, osHs may require that contractor remove such individual
fromprovidingservicestoDSHsStudentsunderthisContract.
b. DSHS shall notify the contractor of this decision verbally and in writing and the contractor shall'
within 24 hours, remove that individual from providing direct services to DSHS Students' Failure to
do so may resull in a Corrective Action Plan'
Compliance with Corrective Action Plan
ln the event that DsHS identifies deficiencies in contractor's performance under this contract, DSHS
may establish a corrective Action Plan when presented with a corrective Action Plan' contractor
agrees to undertake the actions specified in the plan within the timeframes given to correct the
deficiencies. Contractor's failure to do so shall be grounds for termination of this Contract'
Order of Precedence in DVR Process
ln the event of any inconsistency or conflict between the Terms and conditions of this contract and the
DVR Service Delivery outcome Plan (sDoP) and the Authorization for Purchase (AFP)' the
inconsistency or confrictihart be resorved oy'giving precedence this contract in its entirety. Terms or
conditions that are more restrictive, specificlol'p"rtiirr"r than those contained in this contract shall not
be construed as being inconsistent or in conflict'
Disputes
when a dispute arises over an issue concerning the terms of this contract, the following process is
used to address the disPute:
a. The contractor and DVR shall attempt to resolve the dispute through informal means between the
contractor and the assigned DVn counselor. For those contracts where a DVR Counselor is not
assigned, tfre Contracio"r shall attempt to iesotve the dispute with the contact person identified on
the first Page of the contract.
b. lf the contractor is not satisfied with the outcome of the resolution with the DVR Counselor or
DSHScontactperson,theContractormaytuOtit'-'uq'"ttforreviewofthedisputedissue'in
writing,forreviewwithinthirty(30)businessdaysoftheoutcometo:
,13
14
15.
16.
DSHS Central Contracl Serv,ces
ooiZCf County Program Agreement (10-31-2017)
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Special Terms and Conditions
DVR Director
DSHS/DVR
PO Box 45340
Olympia WA 98504-5340
c. The Director may appoint a designee to review the disputed issue.
d. A request for dispute resolution shall include:
(1) Name of the requester'
(2) Contractof's name, full address, phone number, and email'
(3) Contract number.
(4) Description of the issue in dispute.
(5) A statement describing the requester's position on the issue in dispute, including any
documentation that supports this position'
(6) Steps already taken to resolve the dispute'
e, The reviewer may request additional supporling documentation from either party to assist in
reaching a fair resolution.
f. The Director shall issue a written decision to the Contractor within thirty (30) business days of
receipt of all information relevant to the issue'
g, The dispute resolution process described above is the sole administrative remedy available under
this Contract.
DSHS Central Contracl Seryices
6017CF County Program Agreement (10'31-2017)Page 15
1
SPecial Terms and Conditions
Exhibit A - Data Security Requirements
The words and phrases listed below, as used in this Exhibit, shall each have the following
b
c
Definitions
definitions:
a.
e
.AES, means the Advanced Encryption Standard, a specification of Federal lnformation Processing
Standards Publications for the encryption of electronic data issued by the tlalio$ lnstttute of
Standards and Technology (https //nvlpubs. nist.govi nistpubs/FIPS/NlST. FIPS' 197-upd 1 'pdO'
,,Authorized Users(s)" means an individual or individuals with a business need to access DSHS
confidential lnformation, and who has or have been authorized to do so.
"Business Associate Agreement" means an agreement between DSHS and a contractor who is
receiving Data covered-under the privacy and"security Rules of the Health lnsurance Portability
and Accountability Act of 1996, The agreement estabjishes permitted and required uses and
disclosures of protecGd health informaltion (PHl) in accordance with HIPAA requirements and
prouio*. obligations for business associates to safeguard the information-
,,category 4 Dala" is data that is confidential and requires special handling due to statutes or
regulations that require especially strict protection oi the data and from which especially serious
consequences may arise in the event of any compromlse.of such data' Data classified as Category
4 includes but is not limited to data protected Oy: ine Health,lnsurance Portability andAccountability
Act (HlpAA), pub. t. lOt+-191 as amenOeO UV tire Healtfr lnformation Technology for Economic and
Ctinicat Health Act of zoog iF{r6CH), 45 CFit parts 160 and 164; the Family Educational Rights
and privacy nct (rrnFn), jo u s c.'S 1232g;34 CFR Part^99; lntetnal Revenue Service
Publication 1075 (https://www.irs.gov/publiri-pOf/p1075'pdf);Su.bstance Abuse and Mental Health
services Administration regulations on confidentiality of Alcoho,l and Drug Abuse Patient Records'
42 CFRpart2', and/or CririinalJustice lnformation Services, 28 CFR Part'20'
"Cloud" means data storage on servers hosted by an entity other than the Contraclor and on a
network outside tne contro'l of the contractor. Physical storage of data in the cloud typically spans
rrfiipf" servers anO otten multiple locations. Cloud storage can be divided between consumer
grade storage for personal files and enterprise grade for cbmpanies and governmental entities'
Examples of consumJigi"J" ttorage wouh inc-lude iTunes, Dropbox' Box'com' and many other
entities. Enterprise
"rouiJ
ulnoors i"nclude lVlicrosoft Azure, Amazon Web Services, and Rackspace'
,,Encrypt" means to encode confidential lnformation into a format that can only be read by those
possessing a *key"; a password, digital certificate or other mechanism available only to authorized
users. Encryption must use a key length of at least 256 bits for symmetr!9 xry:, or.20.48 bits for
asymmetric t<e's. Wnenl r,rt"tti."fey is used, the Advanced Encryption Standard (AES) must
be used if available.
,,FedRAMP" means the Federal Risk and Authorization Management Program (see
www.fedramp.gov), which is an assessment and authorization process that federal government
agencies have been directed to use to ensure security is in place when accessing Cloud computing
products and services.
,,Hardened Password" means a string of at least eight characters containing at least three of the
following four character classes: uppercase "lpt-tr-o*ti",
lowercase alphabetic, numeral' and special
charactirs such as an asterisk, ampersand, or exclamation point'
d
f
g
h
DSHS Central Contract Services
6O17CF County Program Agreement (10-31-2017)
Page 1 6
k.
Special Terms and Conditions
.Mobile Device" means a computing device, typically smaller than a notebook, which runs a mobile
operating system, such as iOd, AnJroid, ol. Windo*r Phone. Mobile Devices include smad phones,
most tablets, and other form factors.
,,Multi-factor Authentication" means controlling access to computers and other lT resources by
requiring two or *orrpi"."= of evidence that-the user is who they claim to be' These pieces of
evidence consist of something the user knows, such as a password or PIN, something the user has
such as a key card, .*"tt ""i0, or physical token; and something the user is, a biometric identifier
such as a fingerprint, facial ..an, oi retinal scan. ;'PlN" means a personal identification number, a
series of numbers which act as a password for a device. since PlNs are typically only four to six
characters, plNs are uiually used in conjunction with another factor of authentication, such as a
fingerprint.
,,portable Device" means any computing device with a small form factor, designed to be transported
trom fLce to place. portable devices are primarily battery powered devices with base computing
resources in the form of a processor, memory, storage, and network access' Examples include' but
are not limited to, mobile pnon"t, tablets, anO laptop!. Mobile Device is a subset of Portable
Device.
,,portable Media" means any machine readable media that may routinely be stored ormoved
independently of computing devices. Examples include magnetic tapes, opticaldiscs.(CDs or
DVDs), flash memory'(thurib drive) devices, external hard drives, and internal hard drives that have
been removed from a computing device'
,,secure Area" means an area to which only authorized representatives of the entity possessing the
Confidential lnformation have access, and access is controlled through use oi a key, card key'
combination lock, or comparable mechanism. Secure Areas may include buildings' rooms 0r
locked storage containers (such as a filing cabinet or desk drawer) within a room, as. long as access
to the Confidential lnformaiion is not avaiiable to unauthorized personnel' ln otheruvise Secure
Ar""., such as an office with restricted access, the Data must be secured in such a way as to
prevent access by non*authorized staff such as janitorialorfacility security staff, when authorized
Contractor staff are not present io ensure that nbn-authorized staff cannot access it'
.Trusted Network" means a network operated and maintained by the Contractor, which includes
security controls sufficient to protect OSHS Data on that network. Controls would include a firewall
between any other networks, access control lists on networking devices such as routers and
switches, and other such mechanisms which protect the confidentiality, integrity, and availability of
the Data.
,,Unique User lD" means a string of characters that identifies a specific user and which, in
conjunction with a password, pJssphrase or other mechanism, authenticates a user to an
information system.
L
m
tt
o-
2. AuthoritY. The securitY req uirements described in this document reflect the applicable requirements of
policies and standards of th e Washington Technology Services Agency
\Na o\/?co &.liel,:l ca tar &fielci
and of the DSHS lnformation Security
these requirem ents can be found here
private-a nd-sectire , which is a site dev
DSHS Central Contracts and Lega I Services
3.Administrative Gontrols. The Contractor must have the following controls in place;
USHS Cenlral Contract Services
6017CF County Program Agreement (10-31-2017)
n
Page I 7
4.
SPecial Terms and Conditions
a. A documented security policy governing the secure use of its computer network and systems' and
which defines sanctions that may n" rppii"Olo Contractor staff foiviolating that policy'
b,lftheDatasharedunderthisagreementisc|assrfled3:9:l:.9"'y4,theContractormustbeaware
of and compliant with the applicable legai or regulatory requiremLnts for that Category 4 Data'
c. lf confidential lnformation shared under this agreement is. ctassified as category 4, the contractor
must have a documented risk "rru.r**nt'i"iin"1'ttem(s)
housing the Category 4 Daia'
Authorization, Authentication, and Access. rn order to ensure that access to the Data is limited to
autnorizeO staff, the Contractor musl:
a. Have documented poricies and procedures governing access to systems with the shared ljata'
b. Restrict access through administraiive, physical' and technical controls to authorized staff'
c. Ensure that user accounts are unique and that any given user account logon lD and password
combination is known onty to the one #i ;y* i::irll r,at alcount is issigned' For purposes of
non-repudiation, it must always be possible io determine wrricn emptoyee performed a given action
on a system housing the Data based #il;;l;;togon lo used to perform the action'
d. Ensure that only authorized users are capable of accessing the Data'
e.Ensurethatanemployee'saccesstotheDataisremovedimmediately:
(1) Upon suspected compromise of the user credentials'
(2) When their employment, or the contract under which the Data is made available to them, is
f
terminated
(3) when they no longer need access to the Data to fulfill the requirements of the contract'
Have a process to periodically review and verify that only authorized users have access to systems
"ont"inii"'g
DSHS ionfidential lnformation'
when accessing the Data from wtthin the contractor's network (the Data stays within the
contractor's network at all times), enforce p""*ota and logon requirements for users within the
Contractor's network, including
(1) A minimum length of 8 characters, and containing at leastthree of thefollowing character
ctasses: ,pp"r""."-t;;;=, il;*;r" d;;";r'i-,"i"r", and special characters such as an
asterisk, ampersand, or exclamation point'
(2) That a password does not contain a user's name' logon lD' or
(3) That a password does not consist of a single dictionary word'
'"' prttpn?ase wni"n consists of multiple dictionary words'
(4)Thatpasswordsaresignificantlydifferentfromthepreviousfourpasswords.Pa
increment oy srmply adding a numberci" n"t considered significantly different'
when accessing confidential lnformation from an external location (the Data willtraverse the
tnternet or otherwise ii"""i "rtiioe
the conira;;; ;;Mtrk), mitigate risk and enforce password
and logon requirumenil;;; ;;;t; ty employing measures including:
h
any form of their full name'
A password maY be formed as a
sswords that
DSHS Central Contract Services
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Special Terms and Conditions
(1) Ensuring mitigations applied to the system don,t allow end-user modification
(2) Not allowing the use of dial-up connections'
(3) Using industry standard protocols and solutions for remote access' Examples would include
RADIUS and Citrix.
(4) Encrypting all remote access traffic from the external workstation to Trusted Network or to a
component witnin ihe irusted Network. The tratfic must be encrypted at all times while
traversing "ny
netwoit<, i..liOing the lnternet, which is not a Trusted Network'
(5) Ensuring that the remote access systenr prompl: i"j,l:-"-tillentication
or performs arttnmated
' ' session-termination afier no more than 30 minutes of inactlvlty'
(6) Ensuring use of Multi-factor Authentication to connect from the external end point to the internal
end point.
Passwords or PIN codes may meet a lesser standard if used in conjunction with another
authentication mechanism, such as a biometii- itingerprint, face recognition, iris scan) or token
(software, hardware, smart card, etc') in that case:
(1) The PIN or password must be at least 5 letters or numbers when used in conjunction with at
least one other authentication factor
(2) Must not be comprised of all the same letter or number (11111,22222, aaaaa' would not be
acceptable)
(3) Must not contain a "run" of three or more consecutive numbers (12398,98743 would not be
acceptable)
lf the contract specifically allows for the storage of confidential lnformation on a Mobile Device'
passcodes used on the device must:
(1) Be a minimum of six alphanumeric characters
(2) Contain at least three unique character classes (upper case, lower case, letter' number)'
(3) Not contain more than a three consecutive character run' Passcodes consisting of 12345' or
abcd'12 would not be accePtable'
k. Render the device unusable after a maximum of 10 failed logon attempis'
Protection of Data. The contractor agrees to store Data on one or more of the following media and
protect the Data as described:
a. Hard disk drives. For Data stored on local workstation hard disks, access to the Data will be
restricted to Authorized User(s) nV ,"qriring iogon to the local workstation using a Unique User lD
and Hardened password or other auttreniic"atio"n mechanisms which provide equal or greater
security, such as biometrics or smart cards'
b. Network server disks. For Data stored on hard disks mounted on network servers and made
available through shared folders, """""" to the Data will be restricted to Authorized Users through
the use of access control lists which *irigr"nt access only after the Authorized User has
authenticateo to in" n"t*o* using a Uni{ue User lD and Hardened Password or other
5.
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d
e
f
Special Terms and Conditions
authentication mechanisms which provide equal or greater security, such as.biometrics or smart
cards, Data on disks mounted to such."ru"-o-tr.ibe located in an areawhich is accessible only
to authorized personnel, with access .onttott"U tniough use of a key, card key' combination lock' or
comparable mechanism'
For DSHS Confidential lnformation stored on these disks, deleting unneedeo Da!3 is sufficient as
long as the disks l."rnrin in a secure Area and otherwise meet the requirements listed in the above
paragraph. oestructiJn oitn" o"tt, as outtineo below in Section 8 Data Disposition' may be
deferred untilthe disks are retired, replaced, or otherwise taken out of the secure Area'
Optical discs (GDs or DVDs) in localworkstation optical disc drives' Data provided by DSHS
on optical dlscs whiclr *itl t * used in localworl<station optical disc clrives and which will not be
iransported out of a Secure Area' When not in use for the contracted purpose' such discs must be
Stored in a Secure nr"a. Worf<stations wnicn access DSHS Data on optical discs must be located
in an area which is accessible only to "utf,oiiz"J
per"onnel, with access controlled through use of a
["V, ""Jr."y, combination lock, or comparable mechanism'
Opticaldiscs (CDs or DVDs) in drives or jukeboxes.attached to servers' Data provided by
DSHS on optical Oiscs wfrlcy, *itt n" attachei to network servers and which will not be transported
out of a secure nrea.-Rccess to Data on tnese discs will be restricted to Authorized Users through
the use of access controi iists wlrich will grant access only afier the Authortzed User has
authentlcated to the network using a unique User lD and Hardened Password or other
authentication mechanisms which provide
"quir
o1" greater s.ecurity, such as.biometrics or smart
cards. Data on discs attached to such t"tl-i. tr.ibe located in an area which is accessible only
to authorized personnel, with acces= controlled through use of a key' card key' combination lock' or
comparable mechanism.
Paper documents. Any paper records must be protected by storing the records in a secure Area
which is only accessible to authorized personnel" When not in use,iuch records must be stored in
a Secure Area.
Remote Access. Access io and Use of the Data over the state Governmental Network (sGN) or
Secure Access Wasfringion-(aAry will be co*iolted by DSHS staff who will issue authentication
credentials (e.g. a Unique User lD anO larOenuJ puss*orO) to Authorized Users on Contractor's
staff. contractor will notifu DSHS staff immediately whenever an Authorized User in possession of
such credentials is terminated or otherwise ieaves'the employ of the Contractor' and whenever an
Authorized User's Ouii"t "n"tg" such that the Authorized User no longer requires access to
perform work for this Contract.
Data storage on portable devices or media'
(1) Except where otherwise specified herein, DSHS Data shallnot be stored by the contractor on
portable devices oi t"ai" unless speciticalty authorized within the terms and conditions of the
Contract. ff so "uinoited,
the Data shall be given the following protections:
(a) EncryPt the Data.
(b) control access to devices with a Unique User lD and Hardened Password or stronger
authenticationmethodsuchasaphysicaltokenorbiometrics.
(c) Manually lock devices whenever they are left u.nattended and set devices to lock
automaticallyafteraperiodofinactivity,ifthisfeatureisavailable,Maximumperiodof
inactivitY is 20 minutes.
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SPecial Terms and Conditions
(d) Apply administrative and physicalsecurity controls to Portable Devices and Portable Media
by:
i. Keeping them in a Secure Area when not in use'
ii. Using check-in/check-out procedures when they are shared' and
iii. Taking frequent inventories'
(2) when being transported outside of a secure Area, Portable Devices and Portable Media with
DSHS Confidential lnformation must be unJer tne'pfrysical control of Contractor staff with
authorization to accoos the Data, even if the Data is encrypted'
Data stored for backuP Purposes'
(1) DSHS Confidential lnformation may be stored on Portable Media as partof a contractor's
existing, oo"ur"ni"J ;;;ilp process for business continuity or disaster recovery purposes'
such storagu i, "ufirir"J ,jniir sucn time as inai meaia woutd oe reused during the course of
normal backup operations. lf backup t"Ui' is retired while DSHS Confidential lnformation still
exists upon it, such media will be uestroyeJ "t
tnit time in accordance with the disposition
requirements below in Section 8 Data Disposition'
(2) Datamay be stored on non-portable media (e'g' storage Area Network drives' vir'tual media'
etc,) as part of a Contractor's existing, docume-nteA Uait<up process for business continuity or
disaster ,.""ou"ry p-u;;;;;.
-tf
so, sriCn"m"Oia witt be protecied as otherwise described in this
exhibit. tt tnis meiia L retired while DSHS confidentiil lnformation still exists upon it' the daia
will be destroyed "tlnut
time in ...oro"nl *ltn ine oisposition requirements below in section 8
Data DisPosition.
cloud storage. DSHS Confidential lnformation requires protections equal to or greater than those
specified elsewhere witnintnis exhibit. crorJ sio*de of Data is.problematic as neither DSHS nor
the Contractor has .onirot of the environment in which the Data is siored' For this reason:
(1)DSHSDatawillnotbestoredinanyconsumergradeCloudsolution,unlessallofthefollowing
conditions are met:
(a)ContractorhaswrittenproceduresinplacegoverningY:?oftheCloudstorageand
contractor attests in writing that all sucn prJceoures will be uniformly followed'
(b)TheDatawillbeEncryptedwhilewithintheContractornetwork,
(c) The Data will remain Encrypted during transmission to the Cloud'
(d)TheDatawillremainEncryptedatalltimeswhileresidingwithintheCloudstoragesolution.
(e) The contractor will possess a decryption r,lY Igt the Data, and the decryption key will be
possessed only Uy ine Contractor and/or DSHS'
(f) The Data will not be downloaded to non-authorized systems' meaning systems that are not
on either the DSHS or Contractor networks'
(g) The Data will not be decrypted until downloaded onto a computer within the control of an
Authorized ur"i ana within either the DSHS or Contractor's network.
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SPecial Terms and Conditions
(2)DatawillnotbestoredonanEnterpriseCloudstoragesoluttonunlesseither:
(a)TheCloudstorageprovideristreatedasanyotherSub-Contractor,andagreesinwritingto
all of the requirements within this exhibit; or'
(b) The Cloud storage solution used is FedRAMP certified'
(3)lftheDataincludesprotectedhe^althinformationcoveredbytheHealthlnsurancePortabilityand
Accountability Act (HlpAA), the cloui piouial'. must sign a Business Associate Agreement prior
to Data being stored in their Cloud solution'
System Protection. 1o prevent comptomise uf systems which contain DSHS Data or ihrough Which
that Data Passes;
a'SystemscontainingDsHsDatamusthaveallsecuritypatchesorhotfixesappliedwithin3months
of being made available'
b, The contractor will have a method of ensuring that the requisite patches and hotfixes have been
applied within the required timeframes'
c. Systems containing DSHS Data shall have an Anti-Malware application, if available, insialled'
d. Anti.Malware software shall be kept up to date. The product, its anti.virus engine, and any malware
databasethesystemuses,willbe'nomorethanoneupdatebehindcurrent.
Data Segregation.
a.DsHsDatamustbesegregatedorotherwisedistinguishablefromnon-DSHSdata.Thisisto
ensure that when no longer needed by tre bontru"6r, all DSHS Data can be identified for return or
destruction. lt also aids in determining *n"inur osHs oata has or may have been.compromised in
the event of a security breach. ns ,u"n,'ln" oi t"t" of the following methods will be used for data
segregation.
(1) DSHS Data will be kept on media (e'g
non-DSHS Data' And/or,
hard disk, optical disc, tape, etc') which will contain no
(2)DSHSDatawillbestoredinalogicalcontaineronelectronicmedia,suchasapartitionorfolder
dedicated to DSHS Data' And/or,
(3) DSHS Data will be stored in a database which will contain no non-DSHS data' And/or'
(4) DSHS Data will be stored within a database and will be distinguishable from non-DSHS data by
the value ot a specific field or fields within database records'
(5) When stored as physical pa.per documents, DSHS Data will be physically segregated from non-
DSHS data in a drawer, folder, or other container'
when it is not feasible or practicalto segregate DSHS Data from non-DSHS data' then both the
DSHS Data and the non-DSHS data witn wiilnitis "orrlngled must be protected as described in
7
b.
this exhibit.
8.Data Disposition. when the contracted work has been completed or when the Data is no longer
needed, except ", noi"J above in Section ;';, D;; shall oe returned to DSHS or destroyed' Media on
which Data may be =to-r"J"na "ssociated
,"""ptrUtu methods of destruction are as follows:
DSHS Central Contract Services
aiitcf county Program Agreement (10-31-2017)
Page 22
Will be edData stored on:
character data, or
Degaussing sufficiently to ensure that the Data
cannot be reconstructed, or
the Data at
or single
which willovenryrite
using either random
Using a "wi
least three
pe" utilitY
(3) times
P d the disk
Removable media (e'g. floppies, USB flash drives'
portable hard disks) excluding optical discs
hard disks, orServer or workstation
theedidfictedrm,contra provahnhrouggRecycli
theaturesthassthewithtractconrecycler
rotectedilwlbeofataDconlnformation
r ConfidentialPaper documents with sensitive o
incinerationOn-site shredding, P ulptng, orlnformation
health
informatio n
entialConfidINcontaumentsingdocPape
rotectededpciahangullingspreqnng
ethdefaccoorngshreddmpletelYnotngclnnerati
iveabrascoarsewithasurfacereadable
CDs or DVDs)Opticaldiscs (e.g
AUS in reddishcrosscutor
M
Special Terms and Conditions
9 Notification of Compromise or PotentialGompromise' The.compromise or potentialcompromise of
DSHS shared Data must be reported to ilre-o-dn-s conta"t designated in the contract within one (1)
business day of discovery. rf no DS_HS coni"Ii i= Gig;"t"0'lritne contract, then the notification must
be reported to the DSHi'Privacy of1cer rt l"6tpti""cylmcer@oshs'wa'gov' Contractor must also
take actions to mitigate the risk of ross ".d ;;;;; *it6l"v n;tication oi other requirements imposed
by law or DSHS.
Data shared with subcontractors. lf DSHS Data provided under this contract is to be shared with a
subcontractor, the contract with the *ru"onii""t* must incrude art of the data security provisions within
this Contract and within any amendmunt., uttlln*"nti' ot exhibits within this Contract' lf the
contractor cannot protect t-he Data ", "rti"JLt"J
*itnin'tnir contract, then the contract with the sub-
contractor must be submitted to the DSHS C"rL"t rpecified for this'contract for review and approval'
10
DSHS Central Contracl Services
6'o"i ici county Program Agreement ( 1 0-3 1 -20 1 7)
Page 23
Exhibit B: SchooL'to-Work Student Guide lnstructions
ThefottowingisabittingguidefortheContractorastheyworkwithstudentsbyfot|owingthepagesofthe
student Guide. As the fottowing sections are completed' the contractor witt use Exhibit E: sTw Bitting
Checktist for Student Guide, provided to the Contractor by DVR'
These instructions witt supportguidanceto schoot-to-work (sTw) contractors as theywork with students
whoareparticipatinginsTW.TobegintheprocessofsTWandtoreviewtheSTwStudentGuide'schedulea
STWlntakeandAssessmentmeetingwiththestudentandtheStudent'sTearn.Duringthismeeting,the
sTWStudent Guide witt be shared with the student, goingthrough the process of sTW and what the student
shoutd expect in their f inat year of Transition
Bitting lnstructions:
1. Bitt $2,000 for the sTW lntake Meeting once the fottowing pages are complete:
r Team Buitding and lnformation
r Team Contacts, Rotes, and Responsibitities
2. Bitt $3,000 for Assessment once the fotLowing pages are complete:
Assessment pages may inctude the fotlowing pages being compteted' as appticabte for the student' as
each student mayget to their emptoyment go;iin1n"i' own way' Alt sources of information may be used to
determine the parts of the assessment' rnis may inctude iob shadows' a Job Foundation Report through
DDCs,workBasedLearningthroughPre-ETS,o'unysollrcetodeterminetheneededinformationto
establ'ishanemptoymentgoat,Thestudentandthestudent,steamwittworktogethertodeterminethis.
The main goat for this section is to get to an emptoyment goat and the next steps for the student '
. STWAssessment
r Job Goal
r Next StePs and Team Actions
3. Bitt $1 ,000 f or the Job seeker Tools once the f oLtowing pages are comptete:
r Job Seeker Toots (determined bythe student's team and have been completed and shared with the
student and DVR)
4. Bitt $2,000 for the Job Offer once the fottowing page is complete:
rJobofferDetaitsonthepagetitted,.YouwereofferedthejoblWaytogo!,,
5.Bitl,$1,000forEmpl'oymentVerificationoncethefotl.owingpageiscomplete:
rFormiscomptetedonthepagetitted,,Congratulations,youareemployed|,,
6. Bitt $5,000 lor Stabitization once the fotl'owing pages are complete:
Your SuPPorts on the Job
Job Stabitization RePort
Ptease note there are additionat pages in the student Guide that do not affect the above payments
a
and are intended to support the student'
S€t'*##n*tqffif,hr*E
Job Seeker:
[Vlonth/Year:
DSHS
WASHINGTON 5TATE
Department of Soclal
and Health services
Pleruss eheck *ut w*ent *s r^*enns
*n yotxr Student #u*d*!
Here is the monthly summary of progress made towards your job goal
. i ftfo additional steps have been completed this month' Onty the Monthly Summary above
to share the progress being made towards supporting you in being employed!
{
t
I
i
Phase One
Team Building and lnformation i i t"um Contacts, Roles, and Responsibilities
Assessment lnformation i : .lotr Goal Established ' i Next Steps and Team Actions
Phase Two
i
-
i lon Seeker Tools i ; .lon offer Details
Phase Three
i I fmPloyment Verification I Supports on the Job I
Job Stabilization RePort
DtvtStoN oF VOCATtoNAt REHABtLtTATioN I SCHOOL-]O-\/oRK I PAGE 2
Weils*nffiel
Se hee f,-tm-Wor$< Oqres'vEew
The School-to-Worl< program is designed to assist you in finding a job before you exit school in June' ln this
program, you will wort< d-lrectly with a job coach wLo will collaborate with you, your parent(s)/guardian(s)'
school district staff, County Developmental Dis;bilities programs, the Diviiion of Vocational Rehabilitation' and
Developmental Disabilities Admi nistration'
This Sehoofl-tm-Wffirk Studeffit Guide
This guide will be r-rpdated regularly and is designed to house your School-to-Work related information'
asseisments, activity logs, notes, and much more' lt will:
, Ensure key activities and milestones are completed and organized effectively'
. 5upport you in keeping important information in one place'
. Be a great resource to bring to collaboration meetings with your team'
This is a guide for students to ensure key activitles and milestones have been completed and organized
effectively. This tool will support students in keeping important information in one place' and it will also be a
qreat resource to bring to collaboration meetings that occur with support partners and agencies'
5e hoof,-tm-Wffirk Fhases
You will be going through three phases for School-to-Work, all moving you toward your employment goal
The phases are describecl throughout this guide'
Fhase tr: Hntake and Assessffixeffit
This phase includes bringing your team together that will support and guide you through the program' Key
intake and assessment ultiu]ti"r will take place to ensure a positive experience for you'
Fhase 2: -ECIb FEmeemertt
This phase includes conducting and capturing important job placement activities like employment goals' site
visits, job interviews, and more,
Phase 3; ffimPfloYrneffit
This phase serves as an exciting step to complete and capture all employment stabilization information like
employment verification inforiation, completion of the first day of work, and much morel
DIVISION OI VOCATIONAL REI'I/\BILIIATION i SCHOOL-IO'WORK I PAGE 3
Next Steps and Tearm Aetions
you and your team will work together to elecide what next steps are needed t0 support v6u'
Everyone shou!d agl'ee on tasks and actions'
Example:
DVR Counselor will connect You
with a Benefits Planner
Example:
Benefits Planner, Student, FamilY
Example:
Before job start (and again, as
needed)
Task Who When
Tip: Tasks may be added throughout your School-to-Work year'
g ot i"rnoued if ihey are ho longer something you want to explore'
DIVISION OF VOCATIONIAL REHABILITAIION scHooL-TO-WORK I PAGF 4
Fhas* 'l Startst ilmta*qe amd AssessrnerBt
This phase includes bringing your team together that will support and gulde you through the
program. Key lntake "iU?i"rr*ent activitie' *ill
'"L"
place to tn'u'" a positive experience for you'
Team Building and InfonmatEon
Team Building Date
To-Da-List
1. lntroductions / overview of Services / strengths and challenges
2. Assessment Needs
3. Job Goal is Established
OFVoCAIIONALREHABILIIATIoNISCHooL-lO-WoRl(iPAGF5
Name Rol,e/Agency
DlVlSlOl\l
Team eomtaetsu Roles, Responsibifl ities
(This list is more than one Page.)
Your CountY Program School-to-Work Contractor
entity providing local
support for You to find a
job,
Show Up, Speak UP, and
Share! You are the driver of
your services and without
your voice, the team is not
able to supPort You with
your goals, Work with Your
team to get a job' Services
are person-centered and
individualized.
You, the Student
(most important
person on the team)
Supports You in PartnershiP
with school, countY, and
state dePartments to
acquire emPloYment.
Your Parent(s) or
Guardian(s)
School-to-Work CRP/
Subcontractor who
coordinates getting
resources, training, and
supports needed for You to
get a job before You leave
school in June,
Name:
Email:
Phone:
Name
Email:
Phone
Emaih
Phone
Name:Employment
Provider: Your Job
Coach
Email:
Phone:
Name:
Team Member
Role
Team Member
Contact lnformation
Tearn Member
ResponsibilitY to You
oFVoCATIONALRF.HABILIIATIoNISCHooL-lo.WoRKIPACE 6DIVISION
Team eontaets, Roles, Responsibilities
(Continued)
Other Person on Your
Team
Name:
Email
Phone:
Name:
tmarl:
Phone
Name:
Email:
Phone:
Lead role who edits this
School -to-Work Student
Guide monthlY and shares
the most current coPY with
each person listed above at
the end of the month and
gathers information from
you and Your team to share'
Coordinate with schools,
counties, and other state
departments to helP You
get a jnh. Provide job coach
funding, This could be
the Division of Vocational
Rehabilitation, DePartment
of Services for the Blind,
or Tribal Vocational
Rehabilitatlon.
Name:
Email
Phone:
Your Vocational
Rehabilitation
Counselor
Connects You or Your
parent(s) or guardian(s) with
community, countY, and
resources for School-to-
Work,
Your School Teacher
and/or School Staff
Main Keeper of Your
Student Guide
Team Member
Role
Team Member
Contact lnformation
Team Member
ResponsibilitY to You
DlVlSloNI oF VoLATlot\jAL REHABILIIATIoN l SCFiooL-Io-WoRK l PAGE /
Assessment: Gettir"lg Ready for a "lob!
For your team to support you with your job goal, they need to learn more about you' This can happen in so many
*uyt. Xno*ing more about you and who you are is key to success!
lnformation will be gathered about you to get to a goal using multiple sources' such as a Job Foundation report'
job shadowing, or knowin; ;t; about yo-ur f"ttning style. iour joL coach will collect information about your
strengths, skills, and supports needed fo, ,u.."r, onift".;oO' Thiiinformation will be gathered through school'
your your family and friends, and community activities, ai well as conversations and observations with those
supporting You.
History of school attendance and reliability
Behavior support or strategies likely to be needed:
Communication skills:
Learning preferences
Personal hYgiene:
Potential job safetY issues
Summary of Assessment Areas
DtvtstoN oF VOCATTONTAL REHABtLtrArtoi\t I ScHooL-io-woRK I PAGt B
Summary of Assessment Areas (continued)
Stamina/endurance:
Social skills:
Demonstrated skills and task performance
Transportation needs:
work preferences and interests, including: skills and lnterests' Desired work Environment'
Desired Schedule, and travel to and from work:
Notable Accommodations and Necessary Supports:
Vouar jCIb Soel:
Congratulations!YauareanyaurWaytobeingemployed!li
DIVISION OF VOCAIIONAL REI-IABILIIATION scHooL-TO-WCJRI( I PAGE e
Phase 3 Stan*s; Job Filae*ment
This phase includes conductlng and capturlng important joh placement activities like employment
goali, site visits, job interviews, and more'
Resurme on ftfiedia Resq'{me
(Video, PowerPoint, Portfolio, etc')
Job Seeker TooEs
Job seeker tools will be developed to support you as you look for a job' You willwork with your
team to figure or, *;.,u, you need, which may include thefollowing: online portfolios' cover
letters, video resumes, letters of recommendation, Linkedln pages' and more'
Sent to Student:
Sent to DVR Counselor:
Yes I j ttt"
Yes j -l
r.ro
Date sent:
Date sent:
Date sent:
Date sent:
Date sent:
Date sent:
Date sent:
Date sent:
eover Letten (as cieterrmlmee! l'fl needeej by yoL{ amd yCI{"ir tearrys}
Sent to Student:
Sent to DVR Counselor:
,_l
Yes j I No:
Yes i , No:
Em p floye!" Lettea, of Reeornn rnea,n egatfr on (optioma fl }
Sent to Student:
Sent to DVR Counselor:
i
Yes
1
Yes i
No
No
[-inkedln Fage (optional]
Sent to Student: Yes
Sent to DVR Counselor: Yes
No
No
DlVlSloN oF VoCArloN/\L RtHAt]lLlTATloN I SCHooL-To_WoRK l P/\GE 10
You were Offered the "!obl Way to GoB
Did you accept this job offer? Yes ' No
i
lf yes, please complete the section below'
lf not, please complete the section below and explain why the job was not accepted:
l!
Does the job match your original goal on your DVR plan? Yes i I No;
OF VOCATIONAL REHAI]ILITATION I 5CHOOL-TO-WORI( I PAGE 1'1
!l
DIVI,SION
Job Offer Detail,s
Job Goal:
Employer:
Job Title:
Start Date:
Job Duties:
Expected Weekly Hours:
Starting Wage:
Location:
Tra nspo rtation Considerations
Benefits Package
potential Trai n ing Services a nd Date/Additional I nformation:
DtvtstoN oF vocATtoNtAL REHABtLtrAtroN I scHooL-l'o-woRK I PAGE 12
Your Supponts on the iolo!
The strengths You bring to the job
How you will become stable on the job (your fading plan)
Additional training, services, and supports could include
. The support you receive on the job from the beginning will be shared
tr+' *i,i-vJ, unjyort team in the monthly notes at the end of this guide'
DtvtStoN oF vocATtoNAL REt-iABtLilAiloN ISCHOOL-TO-woRK IPAGE 14
Fhase S Starts; HrnBloYment
This phase serves as an exciting step to comptete and capture-all-ernployment stabllizal
lrr." anlplov*"nt ,"riti."i""'uir.rri"a"n, .I.pi"iion "i,tr" flrst day of work, and rnuch more!
eong rata"ilatBcnsE You are Ermpfloyedl
Now what? Please work with your job coach to complete the form below'
Employee's Name:
tmployer's Namc:
Employee's Job Title:
Employer's Address:
ls this a new job? No i I ves i Date Employee started work:
Average Number of Hours Worked Per Week:
Rate of Pay or Salary: 5 Hourly ; Monthly :
Pay Frequency:
i , tr.,o^, Trarn \A/ tes a Month ,Dailyi i Weeklyi , EveryTwoWeeksr ' TwoTin
Tips: i ] *" i I Yes; if yes, how often and how much?
Commissions: I i frf o I Yes;if yes, how often and how much?
Bonuses: ; , No ' ' Yes;if yes, how often and how much?
Overtime: I ; No i Yes; if yes, how often and how much?
Work Schedule (include exact times when possible):
Monday Tuesday Wednesday Thursday Friday
Annually:
t
Monthly I
Saturday SundaY
ls health insurance available: i lto , , Yes
'1. lf yes, did the employee enroll in the health plan?: i i ruo ; '
Yes
a. lf yes, when does the coverage begin?
b, lf yes, what is the employee's portion of the premiums? $
NameandTitleofPersonWhoCompletedThisPage:
Date:
DlVl5loNoFVoCATloNALREHABlLiTAiioNlisCHCoL-To-\^/oRKIPAGE13
Job Stabilization RePort
You are considered stable on the job when the following things happen:
1. Your desired work hours are met (unless you and your team agree the job represents suitable
employment),
2. Your DVR Counselor, your job coach, and your employer agree that you meet your employer's
expectations (this is verified by your job coach)'
3. You are ready for long-term support.
But first...
Did you meet your expected job goal? Yes i . No i i
Was your starting wage what you wanted? Ves i i No
Does the job location meet your expected needs? Ves ; I
Anything else you want to add about your job?
No
DtvlSloNI oF vocATloNAL REHABiLITATIoNI I SC.HOOL-TO-\AIORK i PAGE 1s
Job Stabilization SummarY
Detail and summarize how the placement hours were met (or if the job represents suitable employment):
Detail and summarize how it has been agreed that the employer's expectations have been met' Please provide
descriptions and details as to how stabilization occurred for the employer's expectations to be met:
Detail and summarize how long-term support is set up and will occur:
DIVISION OF VOCATIONAL REHAtsILITAl'ION I SCHOOL-TO-\Ai ORI(Pi\GE I6
HelBfull Resourees
Developmental Disabilities Admin istration
. Website: w f; :i,!1i'l: u1:!9-?1it'kii
. DDA Eligibility lnformation: 'ti'rvvi(1511e-ws q9l:lic!{lqji'rr5rirl}€'r5-r.i:"'Jtltii!g' :ilgittli{'ll
Division of Vocational Rehabilitation, or DVR
. Website: wy1w,r 1hs'r1q,govi,c]vr
. Phone; 1-800-637-5627
Social Security Administration, or SSA
. Website: vvw\^/:!:491ry
. Phone: 1-800-772-1713
Benefit U
. Website;wrl;t,r, i;etl*fl
. Benefit U lnformation: )ui-!:ii-lit-ioeir1:ry{ !-,'-U
GtFrer ffiesmME ees amdlor AddEtionafl eorttaats:
Name:
Phone:
Email:
Other:
Name:
Phone:
Email:
Other:
Dtvl5toN OF VOCATTONIAL REHABtLIl/\TtoN I 5Cl-looL-TO-WORI( | PAGE 17
0ptional Docurnents
Copy of Food Worker Card
Sent to Student: Yes
Sent to DVR Counselor: Yes
copy of current cPR and/or First Aid certification
t:Noi t,
Noi i
Date sent:
Date sent:
Date sentSent to Student: Yes
Sent to DVR Counselor: Yes
Other*
Sent to Student: Yes
:
Sent to DVR Counselor: Yes ' i
i rrro i
Date sent:
Date sent:
Date sent:
Date sent:
Date sent:
ii Noi
Other*
Sent to Student:
Sent to DVR Counselor
Yes
Yes
No
No
No
No
* ldeas of other items to include could be a person-centered plan, other certifications' and other
job-related documents.
DtvlsloNl oF vocATloNAL REHABlLllAlloN i ScHooL-TO-WORI( | PAGE 1B
flVtronthly FrCIE ress RePorts
Below is your story of finding a jobl As your Job Coach works witlr you' they will be adding in
their monthry reports that aie on the first page of this student Guide, you will be able to read the
f rogr"r, .ui" for you. '.the story of your journey to a job!
May
Year
June
Year
July
Year
DtvtsloN oF vocATIONAL REHABtLtTATtoN I scHOOt-TO'WORI( | PAGE 19
August
Year
September
Year
October
Year
DIVISION OF VOCATIONJAL REHABILITA IION SCHOOL-IO-\i ORI( | PAGt ')o
November
Year
December
JanuarY
1
Year
Year
DlVl5loNloFVoCl\TloN/\LREi-'|ABlLlTATloNISCHo(JL-To'WoRl(
I] A G E )1
February
1
rYea
March
1
Year
April
1
Year
Dtvl5loN oF VOC/\TlONr\L ltEFlAtllLl IATlON l scHOOL-io-\/oRK I PAGE'22
May
1
Year
June
1
Year
July
i
Year
DtvlSloN oF vocATloNAL REllABlLllATloN I SCHOOL-lO-vioRK PAG[ 23
August
1
Year
September
1
Year
DIVISION OF VOCATIONAL RFFI ABILIIATION SCHOOL.TO-WORI(P /\ G E 24
AdditEomal eCImments
DtvtsloN oF voc/\TloNAL REHABILITATIONI lScHooL-TO-WORI( lP/\GE 25
Legacy Pilot
S of Students
enrolled in
School to Work
# of Students in
SDOP for
Assessment
f of Students in
SDOP for Job
Placement
# of Students in
SDOP
S of students
Employed
Asotin
Benton
Chelan
Ulark
Columbia
Cowlitz
Douglas
Ferry
Franklin
lsland
Jefferson
King
Kitsap
Kittitas
Lewis
Lincoln
Mason
Okanogan
Pend Orielle
Pierce
San Juan
Skagit
Snohomish
Spokane
Stevens
Thurston
Wahkiakum
Walla Walla
Whatcom
Whitman
Yakima
Total 0 0 0 0 0
Schoolto Work 2026/2027: Graduation Year 2O27 or 2028
*Total enrolled includes students no longer in school, may have moved, not eligible yet/ passed away/ etc
# of Students ln
Y.E,S.
# of Students
Transferred to
DVR Only
S of Students
Transferred to
DDCS (on CSA)
# of Students
Exited STW
Early
Comments
Add'l lnfo to Share
Reasons for STW Exit
0 0 0 0
Legacy Pilot
# of Students
enrolled in
School to Work
# of Students in
SDOP for
Assessment
# of Students in
SDOP for Job
Placement
S of Students in
SDOP
# of Students
Employed
Asotin
Benton
Chelan
Cla rk
Columbia
Cowlitz
Douglas
Ferry
Franklin
lsland
lefferson
King
Kitsap
Kittitas
Lewis
Lincoln
Mason
Okanogan
Pend Orielle
Pierce
San Juan
Skagit
Snohomish
Spokane
Stevens
Thurston
Wahkiakum
Walla Walla
Whatcom
Whitman
Yakima
Total 0 0 0 o 0
Schoolto Work 2026/2 027: Graduation Year 2027 or 2O28
*Total enrolled includes students no longer in school, may have moved, not eligible yet, passed away, etc
# of Students in
Y,E,S.
# of students
Transferred to
DVR Only
# of Students
Transferred to
DDCS (on cSA)
# of Students
Exited STW
Early
Comments
Add'l lnfo to Share
Reasons for STW Exit
0 0 n 0
Legacy Pilot
# of students
enrolled in
School to Work
S of Students in
SDOP for
Assessment
f of Students in
SDOP for Job
Placement
ff of Students in
SDOP
# of students
Employed
Asotin
Benton
Chelan
Clark
Columbia
Cowlitz
Douglas
Ferry
Franklin
lsland
Jefferson
King
Kitsap
Kittitas
Lewis
Lincoln
Mason
Okanogan
Pend Orielle
Pierce
San Juan
Skagit
Snohomish
Spokane
Stevens
Thurston
Wahkiakum
Walla Walla
Whatcom
Whitman
Yakima
Total 0 0 0 0 0
Schoolto Work 2026/2027: Graduation Year 2027 or 2O28
*Total enrolled includes students no longer in school, may have moved, not eligible yet, passed a$'ay, etc
# of Students in
Y.E.5.
S of Students
Transferred to
DVR OnlY
f of Students
Transferred to
DDCS (on CSA)
fi of Students
Exited STW
Early
Comments
Add'l lnfo to Share
Reasons for STW Exit
0 0 0
W3lu;
Division of Vocational Rehabilitation (DVR)
Exhibit E:
School-to-Work Bil I i ng Checklist
Total Billing
lnstructions:
1. The Student Guide is sent monthly to the Student's Team, including the DVR Counselor'
2. The Contractor checks the appropriate box(es) as the corresponding activities are completed in
the Student Guide (one form per student).
3. The Contractor submits this completed form to the assigned DVR Counselor.
4. The DVR Counselor confirms information from monthly submissions of the Student Guide,
verifies activities were completed, then signs and dates the checklist'
5. The DVR Counselor submits for payment.
Notables:
The Student Guide serves as documentation for proof of completion for the payment / activity
point.
The Contractor submits no less than three (3) separate checklists to the assigned DVR
Counselor for each student (submitting all payment points separately is also an option)'
Any questions, please contact the School-to-Work Team at
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Exhibit E: School-to-Work Billing Checklist
DSHS 11-1esA (O4t2026)
Month and YearContractor
Date of SignatureSignature
Student lnitialsAFP Number
To be filled out bY DVR Staff OnlY:
DVR staff sign and date below to confirm
received and to authorize PaYmentitems
Amount
BilledActivity Billed
$ 2,000n tntake Meeting
3 000$
000$1
f, Assessment
X .tob Seeker Tools
2 0 00$[ ;on offer
f Employment Verification $ 1,000
$ 5,000f Stabilization
$