Instructions for Completing STAC 1’s

(Four of Five Slides)

12 Service Information.

"From" and "To" lines 12

Complete "From" and "To" dates for all preschool services: an SED approved program, an SED approved SEIT provider, or for each related service.

Other data items in the Service Information section which require completion according to the program and/or services for the child are:

Special Class and Special Class Integrated Setting

Please complete "Hours per Day" and "Days per Week."

(Items entitled "Individual or Group," "Number of Half Hour Sessions" and "Rate Per Half Hour Session" do not apply to center based placements.)

 Special Education Itinerant Services

Please complete "Individual" or "Group of." The number of children in the group must be shown under "Group of." (Note: STAC will divide the SED approved rate by the group size when calculating costs for the issuance of a STAC-3.) Also complete "Number of Half Hour Sessions" for the total number of half-hour sessions delivered during the "From" and "To" dates.

 Related Services Only

For each related service:

Complete the “Related Service 1, 2, etc” (speech); "Individual" or "Group of," "Number of Half Hour Sessions," (this is the total number of half hour sessions during the From and To service period) and "Rate Per Half Hour Session," for each provider indicated in item 11 using the related services lines Section 12.