Support Costs Sample Form
Student's Name: Jane Doe
Date of Plan: 3/03/04
| What does the student need? |
Who can meet that need? |
How much will it cost? |
Who will fund? |
Next steps… |
| Vocational Profile |
School |
Teacher will write – 15 hours |
School |
Complete Discovery activities. Conduct records review. |
| Development of two work experiences – 1 month each |
ABC Employment Agency |
10 hours at $50/hour = $500 |
Vocational Rehabilitation |
Contact employers. Develop Portfolio. |
| Wages for 2 work experiences – 40 hours each |
ABC Employment Agency (with wages run through ACME Temp. Services) |
$5.15/hr x 80 hours = $412 |
Vocational Rehabilitation |
Complete required employment forms (for taxes, etc.). Notify SSA that Jane will have earnings. |
| Transportation |
Parent |
Mom will transport – 40 total work days (2 hours/day) x 15 minutes roundtrip/day = 10 hours |
Parent |
Develop work schedule so parent knows when her services will be needed. |
| Job Coaching |
School |
Paraeducator will job coach – 30 hours |
School |
Conduct task and environmental analyses once sites have been established. Complete discrepancy analyses once sites have been established. |