application for eligibility of nonpublic ... - … state board of education ... impairment...

- 1 -

Init ial Renewal

ILLINOIS STATE BOARD OF EDUCATION Special Education Services Division

100 North First Street Springfield, Illinois 62777-0001

Program Code 037 Program Code 254

APPLICATION FOR ELIGIBILITY OF NONPUBLIC PROGRAMS TO SERVE STUDENTS WITH DISABILITIES

under Section 14-7.02 of the School Code ELIGIBILITY WILL NOT BE GRANTED PRIOR TO THE DATE THIS APPLICATION IS APPROVED BY THE SPECIAL EDUCATION SERVICES DIVISION OF THE ILLINOIS STATE BOARD OF EDUCATION. Please consult 23 Illinois Administrative Code: 401 Nonpublic Special Education Programs for details. Complete all blanks or indicate that the information requested is not applicable. OFFICIAL NAME OF THE NONPUBLIC PROGRAM PHONE (Include Area Code) Centerview Therapeutic-Day (847) 559-0110 SITE ADMINISTRATOR FAX (Include Area Code) Bonita Simon (847) 559-8199

TITLE E-MAIL ADDRESS Director

ADDRESS (Street, City, State, Zip Code) COUNTY 3444 Dundee Rd, , Northbrook, IL, 60062 Cook

OPERATING OR SPONSORING ORGANIZATION (If Applicable) PHONE (Include Area Code) Center On Deafness (847) 559-0110

CHIEF EXECUTIVE OFFICER FAX (Include Area Code) Dr. Bonita Simon (847) 559-8199

ADDRESS (Street, City, State, Zip Code) 3444 Dundee Rd, , Northbrook, Il, 60062

THIS IS AN APPLICATION FOR: (Check One) (Check One) X Educational Program Only X Co-educational Educational/Residential Program Combination Males Only Residential Program Only Females Only

DATE OF LAST FIRE INSPECTION REPORT (Attach Copy)

04/11/2008

EDUCATIONAL PROGRAMS

ACCEPTED AGE RANGE

14-7.02

ENROLLMENT EDUCATIONAL

PROGRAMS ACCEPTED AGE RANGE

14-7.02

ENROLLMENT

A. Cognitive I. Speech or Language Disability Impairment

C. Orthopedic K. Emotional Impairment Disability

D. Specific L. Other Health Learning Disability Impairment

E. Visual M. Multiple Impairment Disabilities

X F. Hearing N. Developmental Delay Impairment 6-21 11 (3 through 9 Years Old)

X G. Deafness O. Autism 6-21

H. Deaf-Blindness P. Traumatic Brain Injury

- 2 -

Maximum Number of Illinois Students That will be Allowed at this Site Total Number of Students Not Funded by an Illinois School District

The applicant will obey all laws, regulations, and executive orders prohibiting discrimination on the basis of race, color, national origin, sex, age, or handicap and all other laws, regulations, and executive orders applicable to its activities, including but not limited to the School Code (105 ILCS 5/1-1 et seq.), Title IX of the Amendments of 1972 (20 U.S.C. 1681 et seq.), the Illinois Human Rights Act (775 ILCS 5/1-101 et seq.), the Individuals with Disabilities Education Act (20 U.S.C. 1400 et seq.), the Age Discrimination in Employment Act of 1967 (29 U.S.C. 621 et seq.), Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq., 2000e et seq.), the Public Works Employment Discrimination Act (775 ILCS 10/0.01 et seq.), and the Americans with Disabilities Act of 1990 (42 U.S.C.A. 12101 et seq.). Pursuant to Public Act 84-411, Illinois Criminal Background Checks have been conducted on the employees of this Program. Additionally, the undersigned certifies, under penalty of perjury, that he/she is not more than thirty (30) days delinquent in complying with a child support order; that failure to so certify may result in a denial of the renewal, and that making a false statement may subject the undersigned to contempt of court under 305 ILCS 5/10 – 17 – 6 of the Illinois Public Aid Code. I, the undersigned, attest that the information provided on and included with this application is accurate and true, that this Program is in compliance with applicable Rules and Regulations for Approval of Nonpublic Special Education Programs under Section 14-7.02 of the School Code of Illinois and agree that the Illinois State Board of Education has visitation rights to the above mentioned Program and may review the Program services to students for other statutory requirements under Section 14-7.02 of the School Code of Illinois. _

_Sarah Sebert

Signature of Chief School Administrator, Title Date

Signature of Authorized Agent (ISBE Staff) Date

_____________________________________________________

Print Name

The following dates show when the program was updated:

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ATTACHMENT A

ILLINOIS STATE BOARD OF EDUCATION Specialized Support

Special Education Compliance 100 North First Street

Springfield, Illinois 62777-0001

NONPUBLIC PROGRAM INSTRUCTIONAL PROGRAM SCHEDULE FOR 2009-2010 Program Code 037 Program Code 254 Facility Name Centerview Therapeutic-Day Regular School Year Begins (Enter Date*) 09/02/2009

Regular School Year Closes (Enter Date*) 06/10/2010

Student Attendance Days for Regular

School Year (176 Minimum) 176

Number of Instructional Hours per Day

(Minimum of 5 hours per day) Summer School Session Begins (Enter Date*) 06/15/2010

Summer School Session Closes (Enter Date*) 08/27/2010

Student Attendance Days for Summer Session

49

Number of Instructional Hours per Day Total Hours Summer Session (Min 120 Hours)

* All dates on this form must be student attendance days.

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ILLINOIS STATE BOARD OF EDUCATION Center for Special Education

Special Education Compliance Division 100 North First Street


SUMMARY OF RELATED SERVICES Program

Centerview Therapeutic-Day INSTRUCTIONS: Complete the following data as of April 1 of the current year. No other form will be accepted.

1. Review the IEPs of all students currently enrolled under Section 14-7.02 of the School Code of Illinois. 2. Total the direct service minutes per week specified on the IEP for all students in each related service area. (do not include services to

be provided directly by a public school district) 3. Divide by 60. If group services are indicated on IEPs, please note the amount of therapist time that will be needed. 4. Enter total number of IEP-specified direct service hours and minutes on this form. 5. Total the number of students requiring IEP-specified consultative services in each related service area. 6. Enter that number (from Step 5) on this form.

DIRECT

Total Number of Hours and Minutes Specified Per Week RELATED SERVICES

Hours Minutes

CONSULT Total Number of Students

Physical Therapy

Occupational Therapy

Speech

Social Work

Counseling Individual - 11

Group - 25

25

33

0

Art Therapy

Music Therapy

Nursing

Individual aides (indicate FTE)

Other (Specify):

Psychiatric (3 hours 45 minutes Monthly)

56 0

1/11/2010 - 1 -

ATTACHMENT C ILLINOIS STATE BOARD OF EDUCATION

Special Education Services Division 100 North First Street


PERSONNEL RECORD

From: April 15, 2009 Thru: _Present INSTRUCTIONS: FOLLOW INSTRUCTIONS ENCLOSED. NO OTHER FORM WILL BE ACCEPTED. PROGRAM: Centerview Therapeutic-Day

S P E C I A L E D U C A T I O N P R O G R A M A D M I N I S T R A T O R S - ISBE Use Only -

START TERMINA- SPECIAL EDUCATION POSITION ILLINOIS EDUCATOR FULL PART NOTICE DATE TION

DATE PROGRAM ADMINISTRATOR’S

NAME TITLE IDENTIFICATION NUMBER

(IEIN) TIME TIME

Hrs/Wk Start

5 Days End

5 Days Length Vacant

01/05/09 Rena Lovell Program Coordinator 20

08/01/08 Bonita Simon Executive Director 30

S P E C I A L E D U C A T I O N P R O G R A M R E L A T E D S E R V I C E S P E R S O N N E L

- ISBE Use Only - START TERMINA- SPECIAL EDUCATION PROGRAM POSITION ILLINOIS EDUCATOR FULL PART NOTICE DATE TION

DATE PROGRAM RELATED SERVICES PERSONNEL NAME

TITLE IEIN NUMBER OR IDFPR LICENSE

TIME TIME Start 5 Days

End 5 Days

Length Vacant

07/27/98 Rebecca Engstrom Nurse 0 X

12/15/06 Jennifer Eulass Counselor 0 X

11/15/99 Mark Hagler Counselor 0 X

01/01/88 Lerwut Warnsongpigoon Psychiatrist 0 2

1/11/2010 - 2 -

ATTACHMENT D



PERSONNEL RECORD

From: April 15, 2009 Thru: _Present

INSTRUCTIONS: FOLLOW INSTRUCTIONS ENCLOSED. NO OTHER FORM WILL BE ACCEPTED. PROGRAM: Centerview Therapeutic-Day

T E A C H E R S - ISBE Use Only -

START TERMINA- TEACHER’S Class Dis- S/T Age ILLINOIS EDUCATOR FULL PART NOTICE DATE TION

DATE NAME Ability Ratio Range IEIN NUMBER OR

IDFPR LICENSE TIME TIME Start

5 Days End


01/28/08 Heather Hollowell SC D/HH 6:2 15-20 X

08/30/05 Heidi Hondorp SC D/HH 7:2 14-18 X

09/02/09 David Wood SC D/HH 6:2 11-15 X

1/11/2010 - 1 -

ATTACHMENT E

PERSONNEL RECORD


S P E C I A L S U B J E C T T E A C H E R S - ISBE Use Only -

START TERMINA- SPECIAL SUBJECT POSITION ILLINOIS EDUCATOR FULL PART NOTICE DATE

TION DATE

TEACHER’S NAME

TITLE IEIN NUMBER OR IDFPR LICENSE TIME TIME Hrs/Wk

Start 5 Days

End 5 Days

Length Vacant

1/11/2010 - 1 -

ATTACHMENT F

PERSONNEL RECORD


O T H E R N E C E S S A R Y P E R S O N N E L ILLINOIS EDUCATOR - ISBE Use Only -

START TERMINA- OTHER NECESSARY POSITION IEIN NUMBER OR IDFPR LICENSE FULL PART NOTICE DATE TION

DATE PERSONNEL NAME TITLE TIME TIME Start

5 Days End


10/08/07 Tom Bloodworth Aide 0 X

08/21/06 Michael Matzkin Aide 0 X

11/15/80 Judy Roin Nursing Assistant 0 X

10/16/06 Brian Swatek Aide 0 X

1/11/2010 - 2 -

DETAILED IEIN PERSONNEL INFORMATION

D E T A I L E D P E R S O N N E L I N F O R M A T I O N IEIN NAME CERTIFICATE/APPROVAL/LICENSE

Heather Hollowell

Cert Code:09 Secondary Teaching Registered through 2011

03 Elementary Teaching Endrs: Teacher of Students Who Are Deaf or Hard Of Hearing

09 Secondary Teaching Endrs: Teacher of Students Who Are Deaf or Hard Of Hearing

Aprv:Initial Sign Language Interpreter

Heidi Hondorp




Rena Lovell

Cert Code:75 Administrative Registered through 2011

75 Administrative Endrs: General Administrative

03 Elementary Teaching Endrs: Language Arts

03 Elementary Teaching Endrs: Self Contained General Education, Kindergarten - Grade 9

03 Elementary Teaching Endrs: Social Science

10 Special Teaching Endrs: Teacher of Students Who Are Deaf or Hard Of Hearing

10 Special Teaching Endrs: Deaf & Hard Of Hearing - Supervising

1/11/2010 - 3 -

Bonita Simon



75 Administrative Endrs: Superintendent

03 Elementary Teaching Endrs: Learning Behavior Specialist I

03 Elementary Teaching Endrs: Learning Disabilities

03 Elementary Teaching Endrs: Social/Emotional Disorders

09 Secondary Teaching Endrs: Learning Behavior Specialist I

09 Secondary Teaching Endrs: Learning Disabilities

09 Secondary Teaching Endrs: Social/Emotional Disorders

10 Special Teaching Endrs: Speech Correction

10 Special Teaching Endrs: Speech-Language Pathology

David Wood Cert Code:39 Substitute-90 Days Teaching

1/11/2010 - 4 -

1/11/2010 - 5 -

DETAILED NON IEIN PERSONNEL INFORMATION



Lerwut Warnsongpigoon Cert Desc:Physician & Surgeon, Lic. Registered through 07/31/2011

Rebecca Engstrom Cert Desc:RPN Registered through 05/31/2010

Mark Hagler Cert Desc:Lic. Prof. Counselor Registered through 03/31/2011

Jennifer Eulass Cert Desc:LPC Registered through 03/31/2011

Judy Roin

Tom Bloodworth

Michael Matzkin

Brian Swatek

1/11/2010 - 6 -

'0 In i t ia l @ R e n e w a l





under Section 14-7.02 of the School Code

ELIGIBILITY WILL NOT BE GRANTED PRIOR TO THE DATE THlS APPLICATION IS APPROVED BY THE SPECIAL EDUCATION SERVICES DIVISION OF THE ILLINOIS STATE BOARD OF EDUCATION Please consult 23 lllino~s Ad~nlnlstrat~ve Code 401 Nonpubllc Spec~al Educat~on Proqrams for details

TITLE Director

Complele all blanks or indicate that the information requested is not applicable OFFICIAL NAME OF THE NONPUBLIC PROGRAM Centerview Therapeutic-Day

SITE ADMINISTRATOR


/ , / / 5 ( f i d / 07/03/20@2 I I I I I 1

PHONE (Include Area Code) (847) 559-0 1 10 FAX (Include Area Code)

ADDRESS (Street. City. State. Zip Code) 3444 Dundee Rd, , Northbrook, IL, 60062

OPERATING OR SPONSORING ORGANIZATION (If Appl~cable) Center On Deafness

CHIEF EXECUTIVE OFFICER Bonita Simon

EDUCATIONAL ACCEPTED 14-7 02 EDUCATIONAL ACCEPTED 11-7 02

PROGRAMS AGE RANGE PROGRAMS AGERANGE I ENROLLMENT 1 ENROLLMENT

12 A Intellectual I -3 I Speech or Language I

Dlsabll~ty I Impalrlnent I

Rena Lovell I (847) 559-81 99

COUNTY Cook

PHONE (I~iclude Area Code) (847) 559-01 10

FAX (Include Area Code) (847) 559-81 99

C. Orthopedic iL- i

I~npairment

ADDRESS (Street. City. State, Zip Code) 3444 Dundee Rd, , Northbrook, 11,60062

THIS IS AN APPLICATION FOR: (Check One) (Check One)

Educational Program Only Co-educational

Educational/Residential Program Combination Males Only

0 Residential Program Only Females Only

Learnlng Dlsab~l~ty . - -- -- - - - E Visual

jX( F. Hearing

linpairment

! G. Deafness ( 6-21 1

I - n N Developmental Delay I

(3 through 9 Years Old) r--

I 7-- - - - : I -1 0 Aul~sm I I

I

t f -c .. - - i-------- 17 H Deaf-Blindness - 1 i -.i I

I ~ ..-- ~. ~- - . - - . .~ . .. ~- ~ ~ . - - ~ ~ ~ .

hlaxi~nu~n Number of Illhnois Students Thnt whll be Allo~ved a l lh is Site

Total Number of Students Not Funded by an Ill~nois School District

The applicant will obey all laws, regulations, and executive orders prohibiting discr~rniriatron or1 the basrs of race, color, riatrorial origi~i, sex, age. or handicap and all other laws, regulations, and executive orders applicable to its activities, includirig but not 11111ited to the School Code (105 ILCS 511-1 et seq.), Title IX of the Amendments of 1972 (20 U.S.C. 1681 et seq.), the Illinois Human Rights Act (775 ILCS 5/1-101 et seq.). tlie Individuals with Disabilities Education Act (20 U.S.C. 1400 et seq.), the Age Discrimination in Employment Act of 1967 (29 U.S.C. 621 et seq.). Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq., 2000e et seq.), the Public Works Employment Discrimination Act (775 ILCS 10/0.01 et seq.), and the Americans with Disabilities Act of 1990 (42 U.S.C.A. 12101 et seq.). Pursuant to Public Act 84-41 1 , Illinois Criminal Background Checks have been conducted on the employees of this Program. Additionally, the undersigned certifies, under penalty of perjury. that he/she is not more than thiriy (30) days delinquent in complying with a child sirppori order; that fail~rre to so cert~fy r i~ay result in a denial of the renewal, and that making a false statement may s~~b jec t the ~~ndersigned to contempt of court under 305 ILCS 511 0 - 17 - 6 of tlie lllinois Public Aid Code.

I, the undersigned, attest that the information prov~ded on and incll~ded w~th this application is accl~rate and true, that this Program is in compliance with applicable Rules and Regulations for Approval of No~ ip~~b l i c Special Educatio~i Progranis under Section 14- 7.02 of the School Code of lllinois and agree that the lllinois State Board of Educatio~i has vis~tation rights to the above nientioned Proqram arid may review the Program serv~ces t 7ud:nts for 0th r statutory requrremen under Section 14- 7.02bf the Scliool Code of I l l i ~ ~ o ~ s .

-

J L ~ O /4 - . l - - I Signature of Chief School Admmistrator. Title Date Signature of Authorized Agent (ISBE Staff) Date

Dr. Bonita Simon Print Name

The following dates show when the program was updated: 7/12/2010 12/16/2010 2/3/201 1 2/7/20 1 1 3/22/20 1 1 7/1i/20 1 1 3/12/2012 5/1/2012 8/22/2012 222/2013 3/7/20 1 3 6/6/20 13 7/10/2013 11/27/2013 3/12/20 14

ATTACHMENT A




NONPUBLIC PROGRAM INSTRUCTIONAL PROGRAM SCHEDULE FOR 2014-2015


Facility Name Centerview Therapeutic-Day

Regular School Year Begins (Enter Date')

Regular School Year Closes (Enter Date*)

Student Attendance Days for Regular School Year (176 Minimum)

Number of lnstructional Hours per Day (Minimum of 5 hours per day)

Summer School Session Begins (Enter Date*) 06/15/2015




Total Hours Summer Session (Min 120 Hours) 2-k ? as * All dates on this form must be student attendance days.

ILLINOIS STATE BOARD OF EDUCATION Celiter for Speclal Educat~on

Specla1 Educ~t~on Co~lipllance D~b~sion 100 Plorth F~rsl Slreet

Sprlngf~eld, lllirlo~s 62777-0001


Centerview Therapeutic-Day

INSTRUCTIONS:

Complete the following data as of April 1 of the current year. No other form will be accepted.

1. Review the IEPs of all students currently enrolled under Section 14-7.02 of the School Code of Illinois.

2. Total the direct service minutes per week specified on the IEP for all students in each related service area. (do not include servlces 10

be provided directly by a public school district)

3. Divide by 60. If group services are indicated on IEPs, please note the amount of therapist time that will be needed.

4. Enter total number of IEP-specified direct service hours and min~rtes on this form.

5. Total the number of students requiring IEP-specified consultative services in each related service area.

6. Enter that number (from Step 5) on this form.

RELATED SERVICES

I

1 DIRECT COlrISULT i Tolal Number of Hours and Minutes Spec~fied Per Week - rota1 Nuniber of Students

I I i

Speech

I Social Work I !

Physical Therapy


I

7 I

Counseling I I

I 14 J

I

I

Art Therapy 1 1 1

I - . -

Music Therapy

Individual aides (indicate FTE) -- - -- . . - -. - - . . -- - . - -- .. . . - - - . . . - - . - -

I I I

Other (Specily): psychiatric

Nursing 4 I

of 2

Occupant Name:

Address:

Structure Nam:

Suite:

City:

State:

Zip Code:

Inspected By:

Office of the State Fire Marshal Fire Prevention Division

CENTER ON DEAFNESS M.M.H. UNIT 3444 DUNDEE Road

Inspection Date: 7131201 2

Occupant 001 023-CN Number: InspecUonType: Business (Existing)

Requested By:

NORTHBROOK

IL

60062

Frank Richter Property Owner: Center On Deafness Office of the State Fire Marshal Bonita Simon-847-559 JRTC - 100 W. Randolph, Suite 4-600 01 10 Chicago. IL 60601 3444 DUNDEE ROAD Fax: 31 2/81 4-3459 NORTHBROOK 31 2-81 4-2693 I L

60062 Important Info for sprinkler Firfightem:

License Expiration Date: 8/31/2013 Evacuation Capabiltty: Age of clients I occupants: Adult Areas 8 Floor levels to be used: Office Speufrc Information: Office inspect as 023

No violations were observed during this inspection. However, you are still responsible for maintaining compliance with all applicable codes.

Inspector Comments: In Comp.

This inspection report is subject to administrative review. You will be notified in writing within ten (10) business days if any or part of this report is modified.

I f violations are present o r conditions /fire hazards in need o f correction are indicated, you are hereby ordered to remove o r remedy and correct, said dangerous conditions andlor f ire hazards forthwith. A re-ins~ection wi l l be conducted upon notification by you (by letter, email o r fax) to the regional office listed on this report, that the violations have been corrected. Note: the date shown above "Inspector will retrrrn on or hefure (insert drrte)')" is the date that you must notify the office that YOU are readv for re-inspection. The inspector wi l l NOT automatically return on that date.

Should you elect to appeal this order, your request must be postmarked within ten (10) days of your receipt of this order. Such appeal should be directed to the regional office listed at the top o f this report.

Please note: Previous cited violations that appear on not appealable beyond the original ten day period. New violations discovered at the time o f to appeal within ten (10) days o f your receipt

of this order.

Company Representative:

Inspector:

Patrick Palbicke 713120 12

Frank Richter 7131201 2

Page 2 of 2

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PERSONNEL RECORD

From: April 15, 2011 Thru: Present

INSTRUCTIONS: FOLLOW INSTRUCTIONS ENCLOSED. NO OTHER FORM WILL BE ACCEPTED.

S P E C I A L E D U I I

PROGRAM: Centerview Therapeutic-Day I

START TERMINA- SPECIAL EDUCATION PROGRAM DATE 1 TION I PROGRAM RELATED SERVICES

DATE PERSONNEL NAME

START DATE

01 105109

I

J ~ Y ~ ~ P o

-

-

O i ! 2 i i S B I I Rebecca Engstrom

07119il0 I I David Wood

TERMINA- TlON DATE

i

: A T I O N P R O G R A M R E L A T E D S E R V I C E S P E R S O N N E L I I I I - ISBE Use Onlv -

POSITION TITLE

S P E C I A L

SPECIAL EDUCATION PROGRAM ADMINISTRATOR'S

NAME

Rena Lovell

B o n ~ t a S ~ m o n

I 5 Days ( 5 Days ( vacant

FULL TIME

I ILLINOIS EDUCATOR FULL PART IElN NUMBER I TIME I TIME

E D U C A T I O N

POSITION TITLE

Program Coordinator

Executive Dlrector

NOTICE start 1 End I Length

Counselor

P R O G R A M A D M I N I S T R A T O R S

ILLINOIS EDUCATOR IElN NUMBER

PART TIME

HrslWk

;sl"J 20 30

Nurse

Psych~atrist

- ISBE Use Only -

0

0

Start 5 Days

X

NOTICE End

5 Days

2

Length Vacant

ATTACHMENT D



PERSONNEL RECORD

From: April 15. 2011 Thru: Present

INSTRUCTIONS: FOLLOW INSTRUCTIONS ENCLOSED. NO OTHER FORM WILL BE ACCEPTED. PROGRAM Centerview Therapeutic-Day I

T E A C H E R S

FULL TIME

X

X

x

START DATE

06/01/13

09i03113

TEACHER'S NAME

Kelly Bridges

Katherine Citti

TERMINA- TION DATE

PART TIME

Class

SC

SC

091031

- Start

5 Days

13 sc D/m 3:l

Dis- Ability

D/H H

D/HH

ISBE Use Only NOTICE

End 5 Days

-

Length Vacant

S/T Ratio

1 1 1

'!f1( 6.

Age ILLINOIS EDUCATOR IElN NUMBER

3 y / < 3 2 $ ~

13-20 /

ATTACHMENT E PERSONNEL RECORD

From: April 15, 2011 Thru: Present


START DATE

-

--

TERMINA- TION DATE

SPECIAL SUBJECT TEACHER'S

NAME

S P E C I A L

POSITION TITLE

---

S U B J E C T T E A C H E R S

ILLINOIS EDUCATOR IElN NUMBER

FULL TIME

PART TIME

HrsMlk

-

Start 5 Days

-

ISBE Use Only NOTICE

End 5 Days

-

Length Vacant

ATTACHMENT F

PERSONNEL RECORD

From: A ~ r i l 15,2011 Thru: Present

INSTRUCTIONS: FOLLOW INSTRUCTIONS ENCLOSED. NO OTHER FORM WILL BE ACCEPTED. PROGRAM: Centerview Therapeuti~Day

START DATE

06/17/13

091031 13

04114110

I P ~ I P I I E I

--

TERMINA- TlON DATE

33/17/14

OTHERNECESSARY PERSONNEL NAME

Don Arocho

Kathryn Haver

M~chael Matzkin

O T H E R

POSITION TITLE

1 : 1 Aide

I : 1 Aide

1:l Aide

I

%,we

I

0 % ,,

/

I

N E C E S S A R Y P E R S O N N E L ILLINOIS EDUCATOR

IElN NUMBER

0

0

0

FULL TIME

X

X

X

k

PART TIME

- Start

5 Days

ISBE Use Only - NOTICE

End 5 Days

-

Length Vaca~ i t

DETAILED IElN PERSONNEL INFORMATION

I

D E T A I L E D P E R S O N N E L I N F O R M A T I O N IElN I NAME I CERTIFICATEIAPPROVAULICENSE

Simon Bonita

( Professional Educator License Registered through 2017

( Endrs: General Administrative - Kindergarten through Grade 12

I Endrs: Leaming Behavior Specialist I -Grade 6 through Age 21

Endrs: Learning Behavior Specialist I - PreKindergarten though Grade 9

Endrs: Learning Disabil~ties - Grade 6 through Age 21

I Endrs: Leaming Disabilities - PreKindergarten though Grade 9

Endrs: Secondary Educat~on - Grade 6 through Grade 12

Endrs: SociallEmotional Disorders - Grade 6 through Age 21

1 I Endrs: SociallErnotional Disorders - PreKindergarten though Grade 9

Lovell Rena

Endrs: Speech Correction - Kindergarten through Grade 12

Endrs: Speech Language Pathologist (Teaching) - PreKindergarten through Age 21

Endrs' Superintendent - Kindergarten through Grade 12

Professional Educator License Registered through 2016

Endrs: Deaf 8 Hard Of Hearing - Supervising - PreKindergarten through Age 21

Endrs: Elementary Education (Self Contained General Education) - Kindergarten through Grade 9

Endrs: General Administrative - Kindergarten through Grade 12

Endrs: Language Arts - Junior HS - Grade 5 through Grade 8

Endrs: Social Science - Junior HS - Grade 5 through Grade 8

Endrs: Teacher of Students Who Are Deaf or Hard Of Hearing - PreKindergarten through Age 21

Zawacki Tamara


Endrs: Teacher of Students Who Are Deaf or Hard Of Hearing - PreKindergarten through Age 21 Bridges Kelly

C~t t i Katherine

Professional Educator License Reg~stered through 2018


Paraprofessional Educator Endorsement Registered through 2018

Substitute Teaching License Registered through 2018

Endrs: Paraprofessional Educator - PreKindergarten through Age 21

DETAILED NON IElN PERSONNEL INFORMATION

INSTRUCTIONS: FOLLOW INSTRUCTIONS ENCLOSED. NO OTHER FORM WlLL BE ACCEPTED. I PROGRAM: Centerview Therapeutic-Day D E T A I L E D P E R S O N N E L I N F O R M A T I O N

I I

( Cert 0esc:LPC Registered through 03/31/2015

Rebecca Engstrom

David Wood

CERTlFlCATElAPPROVALlLlCENSE

Cert Desc:Physician 8 Surgeon, Lic. Registered through 0713112014 lElN

Cert Desc:RPN Registered through 0513112014

Kathryn Haver

NAME

Lerwut Warnsongpigoon

Cut on Dotted Line

For further reference, the Department is now providing a personal customer identification "Contact Number" which you may use in lieu of your social security number or FEiN number when contacting the Department. Your number is: 1533309

.- -- -- -- . -- - - _- - _-- --_ - _- --- - -- -

m v h i a d ) ~ R ~ REQIBTERED

PROFESSIONAL NURSE

1 I REBECCA R ENGSTROM

Cut on Dotted Line

ILLINOIS STATE BOARD OF EDUCATION Special Education Sewices

100 North First Skeet (N-253) Springfield, Illinois 62777-0001

Mon Tues Wed Thur Fri Mon Tues Wed Thur Fri Mon Tues Wed Thur Fri Mon Tues Wed Thur Fn Mon Tues Wed Thur Fri

NONPUBLIC SPECIAL EDUCATION PROGRAM CALENDAR FOR 2014-2015 PROGRAM CODE PROGRAM CODE

Operating Agency CENTER ON DEAFNESS Nonpublic Program CENTERVIEW THERAPEUTIC SCHOOL PROGRAM CODE

I Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15

3 Mon 4 Tues 5 Wed 6 Thur 7 Fri

10 Mon 11 Tues 12 Wed 13 Thur 14 Fn 17 Mon 18 Tues 19 Wed 20 Thur 21 Fri 24 Mon 25 Tues 26 Wed 27 Thur 28 Fri 31 Mon

Tues Wed Thur Fn

I

3/ LS4 464 w;5

Regular I 0.0 I 1 20.0 1 1 23.0 1 1 15.0 1 1 15.0 1 1 20.0 1 1 20.0 1 1 20.0 1 1 19.0 ( ) 20.0 1 1 8.0 1 ) 0.0 I 1 0.0 1 I Summer I 0.0 I 1 1 1 . 0 I 1 1 9 . 0 1 1 1 9 . 0 1

&S

kj

INDICATE (for billing and auditing purposes, use the codes below) Regular Term - Full Student Atlendance Days (Mm. 5.0 clock hrs) X Regular Term - Half Studenl Attendance Days 1 EX Summer Term - Full Student Attendance Days S Recognized School Holidays HOL Not in Attendance NIA

Proposed Calendar Amended Calendar (by

Slgnatun of Preparer (t submitled electronically. @e in name)

ISBE Penonnel use only:

:::::a,

Complete Ole total number 01 sbdent HOLIDAYS attendance days lor each monOl. Labor Day 09/01/14

Cdumbus Day 10/13/14 Veterans Day 11H1/14 Thanksgiving Day 11/27/14 Christmas Day 12/25/14 New Yeah Day 01/01/15 M.L. King's Birthday 01/19/15 Lincoln's Btrthday 02/12/15 Presidenrs Day 02/16/15

Phone # 847-559-01 10 Casimir Pulaski Day 03/02/15 FAX # 847-559-81 99

Date 4/2/2014

COMPLETE THE FOLLOWNG Regular School Year Begins (Enter Date) 9f3/2014 Regular School Year Closes (Enter Date) 6/10R015 v Student Attendance Days lor Regular School

Year (176 Mlnlmum) 180.0

Summer School Session Begins (Enter Date) 6/15/2015 1/ Summer School Session Closes (Enter Date) -v Summer School Session Attendance Days 49.0 Hours Per Day - Summer Term 5.5 Total Hours Summer Term (Mln 120 H n ) - 269.5

School Holiday (HOL) 8 Not tn Anendance (NIA) 24

q ~ 4 CENTER ON DEAFNESS

3444 Dundee Road Northbrook IL 60062 - 847/559-0110 l T Y 847/559-9493 FAX 847/559-8199

TO: ISBE FROM: Bonita Simon, Executive Director DATE: April 10,2014 RE: Personnel

The Center on Deafness is in the process of seeking a teacher assistant to replace Donald Arocho, who was terminated in March, 2014.

We also realize that Tamara Zawacki will not be the teacher in the classroom for the 2014-2015 school year based on her substitute certification. The Center is in the process of seeking applications at the present time for a teacher with DHH certification.

1 did not know if we should have indicated T O BE NAMED on those attachments in the application. 1 trust this information is helpful.

The Center on Deajkess is dedicated to providing quality services for persons who are deaf or hard of hearing and their families, through educational, vocational, and residential services in a therapeutic, coniniunity based

environment.

Accredited by the Joint Conimission of Health Care Organizations

CHECKLIST TO DETERMINE IF YOUR RENEWAL APPLICATION SUBMISSION IS COMPLETE

Call or e-mail your consultant if you do not understand an item: Heather Zeman at (312) 814 - 8251 or by email at [email protected]

PLEASE SIGN AND RETITRN THIS PAGE IVITII YOlrR RENEWAL APPLICATIOY

1 Identifying ilifoni~ation (address/plione/e-maiI/admi~iis!rator name, etc) at tlie top of tlie - c o v q page has been changed, if necessary.

JThe Illinois State Fire Marshal inspection or out-of-state fire inspection is not over 24 months old or a copy of a more recent one is included.

2 1 f categories or ages of approval have been changed, a revised program description requepng the change is included.

I ! e application is signed (original signature reqoireil).

~ L l n t e d service personnel are sufticient to meet the IEP reds listcd - - on - - the - - Sttm111i11.y of Relate -Services page. Only related services to be provided hy your program arc l i r ter , t _Y -- -

. d ~ e l a t e d services are listed in individual Iiours and minutes or indicated as group hours and - niinutp. Consult services are only listed if indicated on the IEPs.

/

L E I N #s are included for all new personnel with Illinois Professional Educator I.icenses. Note: IElNs can no longer be foklnd online tllrough public acccss. Eclucators must login under "Educator Access" at www.isbe.net1elis to t i ~ i c l their own IEIN.

Current copies of educator licenses for personnel in out-of-stutc l~rograms are inclucled, -

ilnless our records show that tlie license on lile is cul-rent.

d i r r e n t copies of professional licenses ibr personnel such as therapists and other licensed professionals in all programs are included, unless our records show that the license on tile is current.

/Any changes of staff time indicate the dates tlie changes occurred. -

/Dates are given for staff listed as terniiniitcd. newly i~ircc~, or inoved toiliom nnotller program within tlie agency (the elate O F the move, 11ot the clote of tlie 01-iginal start with tlie agenc;y in another positio~i or location).

1 lipelated policies/procedures, program cicscriplion, alltl applicable rcsidcntial lice~lsurc arc included. -------- --_

out of state programs, any renewed accreditation or licensure is included. -

Signature I'llonc numbel-

CENTERVIEW THERAPEUTIC SCHOOL PROGRAM DESCRIPTION

Centerview Therapeutic School is a comprehensive co-educational residential treatment program serving hearing impaired students (ages 6-2 1) who are experiencing emotional and/or behavior disorders. An adjunctive therapy program and an individualized educational plan are carefully blended in order to facilitate maximum benefit from the school program. This blend is the foundation for building the bridge which will return students to their home environment with the greatest potential for success.

ACADEMIC PROGRAM:

The academic program provides instruction in the following areas:

1. Language Arts - The program is individualized and is based on the impact of hearing loss and emotional disturbance on each child's development of language and communication skills. The program includes: remedial and development language, sign language skills, auditory training, speech and speechreading skills and reading and writing. All are integrated into the total day's program.

2. Mathematics - This program is also based on individual needs and ranges from establishment of survival skills to the use of advanced mathematical concepts. The program provides for remedial and tutorial assistance in identified areas of need. Although hearing impairment does not necessarily affect computation skills, problem solving is frequently a deficit area, as this is a language laden task. In addition , learning disabilities may come into play in the development of these skills.

3. Social Science - As in previous subject areas, the course of studies will be individualized for the students. A heightened awareness of interdependent relationships and interpersonal values is one of the overall goals for this area. Issues of identity as they relate to the student's awareness of self, family, community, and the world provides a core theme. These are areas which we have identified as critical issues for hearing impaired students. The developmental tasks of adolescents are characterized by identity crises which are much more profound and complex than those of their hearing counterparts. These foci reflect our understanding of the impact of the emotional behavioral needs of our students. within our social studies cumculum we will study American and World History, American Government, and Current Events.

4. Science - Students will be provided an individualized progam desi meet their educational needs. Biology. Physical. and Earth , -'

most common areas of instruction.

Page Two

5. Health and Physical Education - This program is individualized according to each student's needs. Hearing impaired students have great deficits and misinformation regarding health education. At this point we have integrated these areas into our other courses of study in which we address issues including, but not limited to, human growth and development, sex education, mental health, personal health habits, nutrition, and use of mood-altering substances. Physical Education is provided according to the individual student's abilities and needs.

6. Communication Skills - Total communication is the communication approach embraced at Centerview Therapeutic School. Skill levels within this framework are evaluated and students are monitored for maintenance and improvement throughout all activities.

CAREERIVOCATIONAL PROGRAM: i;

1 1

Currently the career/vocational program is providing instruction in the following areas: k 1. Consumer Education - Consumer Education includes the development of

independent living skills and prevocational orientation. The disruption of the communication process and society's tendency to " overprotect " the handicapped child contributes to lack of independent living skills and realistic occupational goals in hearing impaired adolescents. Clearly, the programs must be individualized according to each student's needs and in most cases will be integrated into other courses of study or activities. Areas such as money management, consumer math, housing, food, transportation, economic problems, etc., are addressed.

2. Work Exploration - A course utilizing field experiences to make students more aware of realistic goals within the community. Oflen times, hearing impaired students become obsessed with goals and jobs that are out of their capability range. This course helps to define and match their own skills with job duties and expectations.

3. WorkshopISupported Employment - Experiences within this division are individualized and are divided into work skills projects and part or full time i

employment. Activities may include, but are not limited to: price rate projects, work adjustment groups, and supported employment (transitional or competitive).

Page Three

THERAPEUTIC PROGRAM

Every student has the opportunity to participate in therapeutic activities. Most of the students are involved in individual counseling on a weekly basis. The focus of individual treatment can be quite varied, from depression to anger management, from impulse control to life skills, or from relationship issues to problem solving. The students are also exposed to various group counseling sessions, both at school and in the residential program. In addition, all the students are involved in a daily therapeutic milieu, where the focus is to not only teach students more appropriate responding in various situations, but to help them learn how to function in a less restrictive environment.

The Behavior Management Program (BMP) is an instrument designed jointly and utilized by clinical, school, and residential programs to provide our students with clear, concise rules and expectations. The goal of BMP is to not only decrease maladaptive behavior, but to teach more appropriate responses. In that vein, the BMP consequences inappropriate behavior, and rewards or reinforces on-task appropriate bbehavior.

NOTE:

Students 17 years old and up are evaluated re: current functioning level and vocational interest and ability.

Most students are placed on a '/z day functional Life Skills Cumculum. This cumculum is made up of activities within the following domains:

1. Communication Skills 2. Community Skills 3. Consumer Skills 4. Vocational Skills 5. Daily Living Skills

RELATED SERVICES:

Currently, the related services program is providing services in the following areas:

I . Psychiatric Consultation - a monthly contract between consulting psychiatrist and student to monitor medication and review mental status.

2. Health Service - A nurse monitors health needs and coordinates use medical services in the community.

3. Counseling services are provided on a 1 : 1 and group basis.

Joint Commission on AccndWn of Healtkare Orpaniratiom

May 19,2003

Robat Van Dyke Exeeucive Dirrctor Cenm on h a f n e s 3444 Dundee Road Nordbro0kIUinois60062

Dear Mr. Van Dyke:

Ibe Joint C a m b i o n is plewd to award accreditation to your organization as a mult of your most receat survey. subject to tbe type I recommcndafi~ll~ olrtlined in tbe attached npoh This acadiation status applies to all services offaed by your o r p d d o a that have been sweyed by tbe Joint Commission, including your behavioral health can savices Y ppoVidQS of oulptieat adult v d o a a l rehabilitation smica, mideatial adult mental ~ d e v e b p m c l l t a l l y &led smica, ad residential adult, W & ~ t mental health services. We con$raluU you on your &om to provide high quality care for those yea save.

Your o r p b t h ' r accraiitatioa includes tbe following additional sites of cm:

8 - 1720 Gremwod, Glenview, IL 8 - 1722 Gremwod, Glenview, IL 8 - 1724 Grrenwoorf Glenview, IL €P - 1726 Grrenwod, Glenview, IL -CP - Greenbriar, Glenview, IL -CP-LpLs,Glrnvie~.IL 4 2 - Quincy Bridge, GIcaview, IL -CV - 1734 Ciremwod, Glenview, IL -CV - Salem Wak NorrhbrooL IL -CV- 1732 Greenwood, Glenview. IL

Thia accreditation u effective for thne yesn from Apnl18,2003, for all SQYices surveyed using appropriate standards fromtbeco a q .

. . f

We direct your attention to two important Joint Commisshm policies. Pink except aa required by law, your accnditation report is cmfidatial. You may, howcva, choose to make it available to the v d o u publics p w e or othm. Second, Joint Conunission policy requires thu yo9 inform aa of my changes in tbe nam or ownaship of your orgauizatim, or the hcalth can savices yoa provide e i k directly or through written apment(s). Your certificate of accreditation must be ntumed if your organidon nquires a revised catificate, chooses to withdraw from accrcditatioa, or allows the iuxditatioa award to urpin.

Congratulations on your achievement of Accreditation with Rcquinmcnts for Improvement.

R d P. Adas.&&, MD, FACPE Executive Vi Resideat Division of Accnditation Operations

- cc: Adrienne Meisel. MBA MS. Board Resident RusscU Reiznu. P)ID. Director

-

One Renaissance Boulevard Member Organizations Amencan Dental Association Oakbrook Terracs. IL 60181 American College of Phys~cians American Hospital kocidtion (630) 792-5000 American College of Surgeons American Medical Assocation httplhww.jcaho.org

CENTERVIEW THERAPEUTIC SCHOOL jz;f ..L.+ - 7- , 6 5 ,p, s'!...

3444 D W D E E ROAD 3 ,. .:'it;

-,&,2! L ~

NORTHBROOK, IL 60062

INTEIVSIVE CARE PROGRAM

PROGRAM DESCRIPTION

The Centerview Entensive Care Program is designed to meet the needs ofhearing impaired students, ages 6 to 21, who are, or may be, a danger to self and others. While the Intensive Care Program follows the curriculum of Centerview School, the service delivery model is modified in order to meet the supervisory, therapeutic and learning needs of cIients who are unable to function in the less restrictive therapeutic environment of Centerview School without additional assistance.

Students meeting the criteria for programming withn the intensive care program have needs over and above the services normally provided by Centerview School. These students will attend school at the Centerview School site and will be an integral part of the Centerview School program, including curriculum and behaviqr management.

F

All students in the program demonstrate a significant hearing loss and have additional handicapping conditions. These conditions include autism and behavioral and emotional disorders exhibiting behaviors such as, inappropriate sexual behavior, documented sexual offenses, suicidal risks, elopement risks, substance abuse, and aggressive behaviors which constitute a danger to self and others. A number of students in the Intensive Care Program at Centerview Therapeutic School require specialized therapy, such as a twelve step program or a sexual offender program. The Intensive Care Program becomes the first step in transition toward a less restrictive educational environment.

All students are residential clients and require the same intensive supervision and services during the residential hours. Students live in apartments or houses accommodating up to four students. The intensive care student may require a private bedroom, and in the case of one of our students, a separate apartment has been necessary.

Depending on the needs of each student, an intensive staffing plan is required. An intensive staffing plan may require any one or all of the following:

1. One to one escort throughout the school day 2. Specialized therapy 3. Individual tutoring 4. One to one instructional aides

The Program is provided through the development of an Individual Educational Plan (IEP.) Educational, Therapeutic and Child Care Teams work together with the local school district and parents or guardian in developing the IEP. Student progress is monitored on a quarterly basis and reported on a quarterly basis to the placing agency, parents or guardians. Review of the IEP is held annually; however, in the case of this Intensive Care Program, reviews are often held more frequently.

While it is anticipated that some of the students will participate in the activities in the Centerview classrooms, the needs of these students are such that they are unable to participate without individual assistance at all times. The student may be unable to tolerate the stimulation of being in a group setting, even though the group may be very small. Individual tutoring by a certified teacher may be required. Individual tutoring may take place in a separate classroom, with every effort being made to gradually transition the student back to a Centerview classroom.

An individual student aide may be required for a specific pupil for a variety of reasons. Maintenance of safety can be a primary concern. Some students demonstrate self- injurious behaviors such as cutting or pulling out eyebrows or eyelashes. Others pose a threat to their peers including subtle manipulation or threatening, name-calling, sexual provocation or outright physical aggression. An aide would be necessary to, first of all, provide eye-to-flesh supervision in order to prevent this range of behaviors from occurring. After the student has been told to "Stop!" whatever negative safety issue he or she may be threatening, the aide may either provide positive reinforcement for compliance or consequences for non-compliance. At times, an individual aide may be required to physically insert themselves into a situation thereby separating students from inappropriate materials, one another, or an adult.

Individual student aides can be of tremendous assistance in helping a student to maintain attention. In the same way an aide would continually monitor a student for safety, a pupil might need consistent supervision to maintain attention. A subtle non-verbal cue from an individual aide may be useful in extending a student's attention span. A more direct statement can prevent them from bothering others, accessing an inappropriate internet site or ignoring their assignment. All of these behaviors significantly reduce a student's academic engaged time and ultimately, their level of progress.

Sometimes, an individual aide is needed to assist a given student in completing tasks in the classroom. This can included a variety of fine-motor tasks such as cutting, finding and circling words, drawing or coloring a map. Direct, individualized instruction at a greatly reduced pace or with significantly modified expectations could also be required. Repetition of instructor input, directions or comments made by peers might be something that an individual aide could supply.

While an individual aide is typically assigned to one student, there is no reason that this aide cannot be engaged in addressing the needs of other students, particularly when they align with those of his targeted student. For example, if two students need to visit the washroom facilities, the aide could escort both of them, monitoring behavior for both

simultaneously. Similarly, two or even three students might need to have the directions for a task repeated or the spelling word list given again. It makes good sense to extend the services of one aide to other students when the situation requires this.

Centerview Therapeutic School is making continual progress toward achieving the goal of implementing a PBIS or Positive Behavior Intervention Supports approach to behavior management. While each student has an individualized behavior program, it has generally emphasized consequences for unacceptable behavior. PBIS has several advantages. It facilitates students being recognized, in a positive manner, for their compliance with accepted standards of behavior and it allows staff to interact with students in a more positive manner. It is the philosophical and practical approach most school districts are presently using. When a student leaves Centerview Therapeutic School's Intensive Care Program and returns to his or her local school, familiarity with PBIS vocabulary, principles and procedures may already have been established, thereby easing the transition.

Centerview Therapeutic School has a strong record of returning students to their local education agencies when therapeutic goals contained in the IEP have been met. The length of time it takes to achieve these goals varies depending on the severity of a student's needs and his or her motivation for addressing them. Some student's needs dictate that they remain at Centerview Therapeutic School for a number of years. Other students are able to return to their local school in the relatively short time of one to two years. All strategies within the Intensive Care Program are directed toward allowing the student to transition to a less restrictive educational environment. It is this successful outcome that the Centerview Therapeutic School staff members are striving to achieve.

CENTERVIEW THERAPEUTIC SCHOOL 3444 DUNDEE ROAD


INTENSIVE CARE PROGRAM

PROGRAM DESCRIPTION

The Centerview Intensive Care Program is designed to meet the needs of hearing impaired students, ages 6 to 2 1, who are, or may be, a danger to self and others. While the Intensive Care Program follows the curriculum of Centerview School, the service delivery model is modified in order to meet the supervisory, therapeutic and learning needs of clients who are unable to function in the less restrictive therapeutic environment of Centerview School without additional assistance.

Students meeting the criteria for programming within the intensive care program have needs over and above the services normally provided by Centerview School. These students will attend school at the Centerview School site and will be an integral part of the Centerview School program, including curriculum and behavior management.

All students in the program demonstrate a significant hearing loss and have additional handicapping conditions. These conditions include autism and behavioral and emotional disorders exhibiting behaviors such as, inappropriate sexual behavior, documented sexual offenses, suicidal risks, elopement risks, substance abuse, and aggressive behaviors, which constitute a danger to self and others. A number of students in the Intensive Care Program at Centerview Therapeutic School require specialized therapy, such as a twelve-step program or a sexual offender program. The Intensive Care Program becomes the first step in transition toward a less restrictive educational environment.



1. One to one escort throughout the school day. 2. Specialized therapy. 3. Individual tutoring. 4. One to one instructional aides.

The Program is provided through the development of an Individual Educational Plan (IEP). Educational, Therapeutic and Child Care Teams work together with the local school district and parents or guardian in developing the IEP. Student progress is monitored on a quarterly basis and reported on a quarterly basis to the placing agency, parents or guardians. Review of the IEP is held annually; however, in the case of this Intensive Care Program, reviews are often held more frequent1 y.

While it is anticipated that some of the students will participate in the activities in the Centerview classrooms, the needs of these students are such that they are unable to participate without individual assistance at all times. The student maybe unable to tolerate the stimulation of being in a group setting, even though the group maybe very small. Individual tutoring by a certified teacher may be required. Individual tutoring may take place in a separate classroom, with every effort being made to gradually transition the student back to a Centerview classroom.

An individual aide may be required for a specific pupil for a variety of reasons. Maintenance of safety can be a primary concern. Some students demonstrate self-injurious behaviors such as cutting or pulling out eyebrows or eyelashes. Others pose a threat to their peers including subtle manipulation or threatening, name-calling, sexual provocation or outright physical aggression. An aide would be necessary to, first of all, provide eye-to-flesh supervision in order to prevent this range of behaviors from occurring. After the student has been told to "Stop!" whatever negative safety issue he or she may be threatening, the aide may either provide positive reinforcement for compliance or consequences for non-compliance. At times, an individual aide may be required to physically insert themselves in a situation, thereby separating students fiom inappropriate materials, one another, or an adult.

Individual student aides can be of tremendous assistance in helping a student to maintain attention. In the same way an aide would continually monitor a student for safety, a pupil may need consistent supervision to maintain attention. A subtle non-verbal cue from an individual aide may be useful in extending a student's attention span. A more direct statement can prevent them from bothering others, accessing an inappropriate internet site or ignoring their assignment. All of these behaviors significantly reduce a student's academic engaged time and ultimately, their level of progress.

Sometimes, an individual aide is needed to assist a given student in completing tasks in the classroom. This can include a variety of fine-motor tasks such as cutting, finding and circling words, drawing or coloring a map. Direct, individualized instruction at a greatly reduced pace or with significantly modified expectations could also be required. Repetition of instructor input, directions or comments made by peers might be something that an individual aide could supply.

While an individual aide is typically assigned to one student, there is no reason that this aide cannot be engaged in addressing the needs of other students, particularly when those align with those of his targeted student. For example, if two students need to visit the washroom facilities, the aide could escort both of them, monitoring behavior for both simultaneously. Similarly, two or even three students might need to have the directions for a task repeated or spelling word makes good sense to extend the services of one aide to other students when the

this.

Centerview Therapeutic School is making continual progress toward achieving the goal of implementing a PBIS or Positive Behavior Intervention Supports approach to behavior management. While each student has an individualized behavior program, it has generally emphasized consequences for unacceptable behavior. PBIS has several advantages. It facilitates students being recognized, in a positive manner, for their compliance with accepted standards of behavior and it allows staff to interact with students in a more positive manner. It is the philosophical and practical approach most school districts are presently using. When a student leaves Centerview Therapeutic School's Lntensive Care Program and returns to his or her local school, familiarity with a PBIS vocabulary, principles and procedures may already have been established, thereby easing the transition.

Centerview Therapeutic School has a strong record of returning students to their local education agencies when therapeutic goals contained in the IEP have been met. The length of time it takes to achieve these goals varies depending on the severity of a student's needs and his or her motivation for addressing them. Some students' needs dictate that they remain at Centerview Therapeutic School for a number of years. Other students are able to return to their local school in the relatively short time of one to two years. All strategies within the Intensive Care Program are directed toward allowing the student to transition to a less restrictive educational environment. It is this successful outcome that the Centerview Therapeutic School staff members are striving to achieve.

STATE OF ~LUN~S I C H I L D R E N AND FAMILY SERVICES

Hay 20, 1986

Patricia Scherer, PhD, President, Board of Directors

Center on Deafness 10100 Dee Rod Des Plrines, I l l inois 60016 . Dear Dr. Scherer: i

F We have received an opinion from our legal staff that the program operated by the Center a Deafness does not f a l l within the purview of our licensing stmducb. To quote:

i 1

"In fac t the Canter on Deafness appears t o be a type of educatimal i.nstitution which i s expressly exempted from our licensing s ta tutes (see 11. R4v. Stat. Chap 23 p-graph 2212.06 (d) md Chap 23 prrgrrph 2212.08(d).]

(r me Center apparently r e m u hmdiupped children who u s mre tbrn 3 y w .old md l ess than 21 years old. Which suggests that it should be consi&red a b o d & boarding school u defined Chapter 23 11. Rev. Stat. 2212.06Cd) which e x q t s tuch ra entity .fm8 the definition of 8 "child ura insti tutionN subject t o de-t.1 liceasure:

"my bOOLfid4 bouding scbool in which childran are p r l . u i l y a g h t brarch I

of eduatinrr to tbora t8ught in public schools, +as 142.. . . and uhich opm-w.1: . y? school basis.. . ."

1ega1 st& ~ W U m a r tb.t the of mtia s b u l d 6 -'. of.* p s 5 ~ h ' ~ p u rcbool is @ae.d in uhea t&ir W n g of your.- is r - -tbtd licror\m.b 063 md -6t i~SU0.8 I ~ C W O JOUT? * j - .

-1. b m ' t fa1 dthirr OW a h i n i r t r a t i v e j e l d i c t i a . .. * . - .+-. & +

QSS i a p l r i . i i off& m a r to n v i n by d i r i o u l ' ~ a u t i a a . p ~ ~ by..,, - tho bard of edurrtion. oftbo Cattar om Dorfness uhicb suggests tbt 065 cclfl. ..': Le#iti.rtalv ~ i & the -tor an Deafmss. . C

.I '

c-. '

' I ' - Pleue feel free t o contact us if such infomation should be available.

Sincerely, h

Licensing Rsprcsentative

m: e lc

CENTERVIEW THERAPEUTIC SCHOOL PROGRAM DESCRIPTION

Centerview Therapeutic School is a comprehensive co-educational residential treatment program serving hearing impaired students (ages 6-2 1) who are experiencing emotional and/or behavior disorders. An adjunctive therapy program and an individualized educational plan are carehlly blended in order to facilitate maximum benefit from the school program. This blend is the foundation for building the bridge which students to their home environment with the greatest potential for success.

ACADEMIC PROGRAM:

The academic program provides instruction in the following areas:

1. Language Arts - The program is individualized and is based on the impact of hearing loss and emotional disturbance on each child's development of language and communication skills. The program includes: remedial and development language, sign language skills, auditory training, speech and speechreading skills and reading and writing. All are integrated into the total day's program.

2. Mathematics - This program is also based on individual needs and ranges from establishment of survival skills to the use of advanced mathematical concepts. The program provides for remedial and tutorial assistance in identified areas of need. Although hearing impairment does not necessarily affect computation skills, problem solving is frequently a deficit area, as this is a language laden task. In addition , learning disabilities may come into play in the development of these skills.

3. Social Science - As in previous subject areas, the course of studies will be individualized for the students. A heightened awareness of interdependent relationships and interpersonal values is one of the overall goals for this area. Issues of identity as they relate to the student's awareness of self, family, community, and the world provides a core theme. These are areas which we have identified as critical issues for hearing impaired students. The developmental tasks of adolescents are characterized by identity crises which are much more profound and complex than those of their hearing counterparts. These foci reflect our understanding of the impact of the emotional behavioral needs of our students. within our social studies curriculum we will study American and World History, American Government, and Current Events.

4. Science - Students will be provided an individualized program designed to meet their educational needs. Biology, Physical, and Earth Science are the most common areas of instruction.

Page Two

5. Health and Physical Education - This program is individualized according to each student's needs. Hearing impaired students have great deficits and misinformation regarding health education. At this point we have integrated these areas into our other courses of study in which we address issues including, but not limited to, human growth and development, sex education, mental health, personal health habits, nutrition, and use of mood-altering substances. Physical Education is provided according to the individual student's abilities and needs.

6. Communication Skills - Total communication is the communication approach embraced at Centerview Therapeutic School. Skill levels within this framework are evaluated and students are monitored for maintenance and improvement throughout all activities.

CAREERIVOCATIONAL PROGRAM:

Currently the career/vocational program is providing instruction in the following areas:

1. Consumer Education - Consumer Education includes the development of independent living skills and prevocational orientation. The disruption of the communication process and society's tendency to " overprotect " the handicapped child contributes to lack of independent living skills and realistic occupational goals in hearing impaired adolescents. Clearly, the programs must be individualized according to each student's needs and in most cases will be integrated into other courses of study or activities. Areas such as money management, consumer math, housing, food, transportation, economic problems, etc., are addressed.

2. Work Exploration - A course utilizing field experiences to make students more aware of realistic goals within the community. Ofken times, hearing impaired students become obsessed with goals and jobs that are out of their capability range. This course helps to define and match their own skills with job duties and expectations.

3. WorkshopISupported Employment - Experiences within this division are individualized and are divided into work skills projects and part or full time employment. Activities may include, but are not limited to: price rate projects, work adjustment groups, and supported employment (transitional or competitive).

Page Three

THERAPEUTIC PROGRAM

Every student has the opportunity to participate in therapeutic activities. Most of the students are involved in individual counseling on a weekly basis. The focus of individual treatment can be quite varied, from depression to anger management, from impulse control to life skills, or from relationship issues to problem solving. The students are also exposed to various group counseling sessions, both at school and in the residential program. In addition, all the students are involved in a daily therapeutic milieu, where the focus is to not only teach students more appropriate responding in various situations, but to help them learn how to function in a less restrictive environment.

The Behavior Management Program (BMP) is an instrument designed jointly and utilized by clinical, school, and residential programs to provide our students with clear, concise rules and expectations. The goal of BMP is to not only decrease maladaptive behavior, but to teach more appropriate responses. In that vein, the BMP consequences inappropriate behavior, and rewards or reinforces on-task appropriate bbehavior.

NOTE:

Students 17 years old and up are evaluated re: current functioning level and vocational interest and ability.

Most students are placed on a Yi day functional Life Skills Curriculum. This cumculum is made up of activities within the following domains:

1. Communication Skills 2. Community Skills 3. Consumer Skills 4. Vocational Skills 5. Daily Living Skills

RELATED SERVICES:

Currently, the related services program is providing services in the following areas:

1. Psychiatric Consultation - a monthly contract between consulting psychiatrist and student to monitor medication and review mental status.

2. Health Service - A nurse monitors health needs and coordinates medical services in the community.

3. Counseling services are provided on a I : 1 and group basis.

s p ~ c $ ~ R - \ ~ ~ S

CENTERVIEW THERAPEUllC SCHOOL ORGANIZATION AL CHART

Board of Directors

Executive Dlrector

Central Offlce Director Director Admlnlstration of f ------* of

Accountlng. Contracts Program Servlces Cllnlcal Services

I I I Director of

Centervlew Health Adjunctive Residential Services - School - and Records Therapy Assistant Principal Nurse Counselors

*** ,,eO Program

.** Assistant 8' ** ** **

Teachers and #@

Teacher Associates ,I*' e*d Chlld Care Vocational ,.#* Workers

**' ****

.** I

**** Aldes

Aldes Crisis Nursing lnterventlon Assistant ...................... Technlcol Supervisor

~pri l , 1995 - ,n .-'Y

CENTERVIEW THERAPEUTIC SCHOOL 3444 DUNDEE ROAD


INTENSIVE CARE PROGRAM

PROGRAM DESCRIPTION

The Centerview Intensive Care Program is designed to meet the needs of hearing impaired students, ages 6 to 21, who are, or may be, a danger to self and others. While the Intensive Care Program follows the curriculum of Centerview School, the service delivery model is modified in order to meet the supervisory, therapeutic and learning needs of clients who are unable to function in the less restrictive therapeutic environment of Centerview School without additional assistance.

Students meeting the criteria for programming within the intensive care program have needs over and above the services normally provided by Centerview School. These students will attend school at the Centerview School site and will be an integral part of the Centerview School program, including curriculum and behavior management.

All students in the program demonstrate a significant hearing loss and have additional handicapping conditions. These conditions include autism and behavioral and emotional disorders exhibiting behaviors such as, inappropriate sexual behavior, documented sexual offenses, suicidal risks, elopement risks, substance abuse, and aggressive behaviors, which constitute a danger to self and others. A number of students in the Intensive Care Program at Centerview Therapeutic School require specialized therapy, such as a twelve-step program or a sexual offender program. The Intensive Care Program becomes the first step in transition toward a less restrictive educational environment.



1. One to one escort throughout the school day. 2. Specialized therapy. 3. Individual tutoring. 4. One to one instructional aides.

The Program is provided through the development of an Individual Educational Plan (IEP). Educational, Therapeutic and Child Care Teams work together with the local school district and parents or guardian in developing the IEP. Student progress is monitored on a quarterly basis and reported on a quarterly basis to the placing agency, parents or guardians. Review of the IEP is held annually; however, in the case of this Intensive Care Program, reviews are often held more frequently.

While it is anticipated that some of the students will participate in the activities in the Centerview classrooms, the needs of these students are such that they are unable to participate without individual assistance at all times. The student maybe unable to tolerate the stimulation of being in a group setting, even though the group maybe very small. Individual tutoring by a certified teacher may be required. Individual tutoring may take place in a separate classroom, with every effort being made to gradually transition the student back to a Centerview classroom.

An individual aide may be required for a specific pupil for a variety of reasons. Maintenance of safety can be a primary concern. Some students demonstrate self-injurious behaviors such as cutting or pulling out eyebrows or eyelashes. Others pose a threat to their peers including subtle manipulation or threatening, name-calling, sexual provocation or outright physical aggression. An aide would be necessary to, first of all, provide eye-to-flesh supervision in order to prevent this range of behaviors from occurring. After the student has been told to "Stop!" whatever negative safety issue he or she may be threatening, the aide may either provide positive reinforcement for compliance or consequences for non-compliance. At times, an individual aide may be required to physically insert themselves in a situation, thereby separating students fiom inappropriate materials, one another, or an adult.

Individual student aides can be of tremendous assistance in helping a student to maintain attention. In the same way an aide would continually monitor a student for safety, a pupil may need consistent supervision to maintain attention. A subtle non-verbal cue from an individual aide may be useful in extending a student's attention span. A more direct statement can prevent them fiom bothering others, accessing an inappropriate internet site or ignoring their assignment. All of these behaviors significantly reduce a student's academic engaged time and ultimately, their level of progress.

Sometimes, an individual aide is needed to assist a given student in completing tasks in the classroom. This can include a variety of fine-motor tasks such as cutting, finding and circling words, drawing or coloring a map. Direct, individualized instruction at a greatly reduced pace or with significantly modified expectations could also be required. Repetition of instructor input, directions or comments made by peers might be something that an individual aide could supply.

While an individual aide is typically assigned to one student, there is no reason that this aide cannot be engaged in addressing the needs of other students, particularly when those align with those of his targeted student. For example, if two students need to visit the washroom facilities, the aide could escort both of them, monitoring behavior for both simultaneously. Similarly, two or even three students might need to have the directions for a task repeated or spelling word list given again. It makes good sense to extend the services of one aide to other students when

APR 0 9 2012

SPEClAL EDUCATION SERVICES

this.

Centerview Therapeutic School is making continual progress toward achieving the goal of implementing a PBIS or Positive Behavior Intervention Supports approach to behavior management. While each student has an individualized behavior program, it has generally emphasized consequences for unacceptable behavior. PBIS has several advantages. It facilitates students being recognized, in a positive manner, for their compliance with accepted standards of behavior and it allows staff to interact with students in a more positive manner. It is the philosophical and practical approach most school districts are presently using. When a student leaves Centerview Therapeutic School's Intensive Care Program and returns to his or her local school, familiarity with a PBIS vocabulary, principles and procedures may already have been established, thereby easing the transition.

Centerview Therapeutic School has a strong record of returning students to their local education agencies when therapeutic goals contained in the IEP have been met. The length of time it takes to achieve these goals varies depending on the severity of a student's needs and his or her motivation for addressing them. Some students' needs dictate that they remain at Centerview Therapeutic School for a number of years. Other students are able to return to their local school in the relatively short time of one to two years. All strategies within the Intensive Care Program are directed toward allowing the student to transition to a less restrictive educational environment. It is this successful outcome that the Centerview Therapeutic School staff members are striving to achieve.

ILLINOIS STATE BOARD OF EDUCATION Spec~al Education Serv~ces /pwd 0 Y 4 5 - e

100 North F~rst Street (N-253) @* Springfield, lllinols 62777-0001

NONPUBLIC SPECIAL EDUCATION PROGRAM CALENDAR FOR 201 3-2014 PROGRAM CODE PROGRAMCODE

Operating Agency CENTER ON DEAFNESS Nonpublic Program CENTERVIEW THERAPEUTIC SCHOOL PROGRAM CODE PROGRAMCODE

I I Aug-13 Sep-13 Oct-13 Nov- 13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14

Mon Tues Wed Thur Fri Mon Tues Wed Thur Fri Mon Tues Wed Thur Fri Mon Tues Wed Thur Fri Mon Tues Wed Thur Fri

Mon Tues Wed Thur

1 Fri 4 Mon 5 Tues 6 Wed 7 Thur 8 Fri

11 Mon 12 Tues 13 Wed 14 Thur 15 Fri 18 Mon 19 Tues 20 Wed 2 1 Thur 22 Fri

27 Wed

I

Regular 1 0.0 1 1 19.0 1 1 23.0 1 1 16.0 1 1 15.0 1 1 20.0 1 1 200 1 1 210 I 1 17.0 1 1 21.0 1 1 8.0 1 I 0.0 I 1 0 0 1 Summer 1 0 0 1 I 100 1 1 190 1 1 20.0 1

INDICATE Regular Term - Full Student Attendance Days (Min 5 0 clock Hrs) Regular Term - Half Student Attendance Days Summer Term - Full Student Attendance Days Summer Term - Half Student Attendance Days Recognized School Holidays Not in Attendance

Proposed Calendar Amended Calendar (by 611114)

Signature of Preparer RENA LOVELL ( ~ f submttted electronically, type In name)

X Complete the total number of student 112X attendance days for each month

S 112s HOL NIA

Phone # 847 5590110 FAX # 847 559 81 99

RECOGNIZED SCHOOL HOLIDAYS

Labor Day 09/02/13 Columbus Day 1 0H4/1 3 Veterans Day 1111 1113 Thanksgiving Day 1 1/28/1 3 Chrtstmas Day 12/25/13 NewYear'sDay 01101H4 M L King's Birthday 01120/14 Lincoln's Birthday 02/12/14 Caslmir Pulaski Day 03/03/14 Memorial Day 05/26/14 Independence Day 7/4/2014

COMPLETE THE FOLLOWING Regular School Year Begins (Enter Date) Regular School Year Closes (Enter Date)

Student Attendance Days for Regular School Year (176 Minimum)

Summer School Sesston Beglns (Enter Date) Summer School Sess~on Closes (Enter Date)

Summer School Sess~on Attendance Days Hours Per Day - Summer Term

Total Hours Summer Term (Mtn 120 Hrs)

[email protected] Date 411 51301 3 School Hol~day (HOL) A .-.----a, Not in Attendance (NIA)

, . . , , ,

3444 Dundee Road Northbrook IL 60062 - 8471559-01 10 l lY 8471559-9493 FAX 8471559-81 99

INTRODUCTION TO THE CENTER ON DEAFNESS

Our Early Intervention Program provides services for ~nfants and toddlers who are deaf or hard of hearing. Our approach includes sign language classes for parents and families of deaf infants and toddlers. Interested persons may call the Center, extension 203.

Our Centerview Therapeutic School provides specialized educational services for deaf and hard of hearing students who have emotional, developmental or behavioral dsorders. The school is approved and licensed by the &ois State Board of Education. The students currently enrolled range in age £rom 6 to 2 1. For more information, please call ed . 214.

We provide Vocational Services for Adults. This Department operates a Sheltered Workshop program and a Supported Employment program n e goal of the Sheltered Workshop is to provide opportunities to be personally pmhctive and, as a result, develop vocational skds and improved self-esteem Several of our Workshop's "praduates" have secured outside employment in the community through our Supported Employment program. For more information, please call extension 236.

Our S.U.C.CESS. Program (Supporting Unique Connections in the Community with Excellent Service and Spirit) provides vocational placement assistance and a Clubhouse. The program facilitates the ability of individuals in developmg their own progress toward independence. Cooperative connections between community resources and our own resources are also a valued aspect of the program. For information, please call extension 236.

Our Residential Department provides structured home-lrke environments for students in our school and for adults. Our staff in the residences teach independent living skills and social interaction skills. Our residences are open 365 days annually. The residential program for children and youth is closeiy coordinated with our Centerview Therapeutic School in order to provide senrices 24 hours daily. Our residences for adults include a Supportive Living Arrangement for adults who are developmentally disabled and a Community Integrated Living Arrangement (CILA) for adults who are mentaliy ill. Our residences are integrated into the community in apartment and townhouse settings. For information please call extension 219.

Our Sign Language Qasm bridge the communication gap between the deaf community and the hearing community. Taught by persons who are dkaf as well as by persons who are hearing, classes range &om Beginners Level to Intermediate and Advan& Classes for children m e t after school hours in the &moon; classes for adults are Tuesday evenings. For more information, please call exqension 203.

Center on Deahess is the administrative agent for the Illinois Semce Resource Center. The Resource Center is available to serve all children, birth through 2 1 years of age, who are deaf or hard of hearing and who also exhibit behavioral or mental health challenges. The ISRC serves such children with resource managemenf intervention, evaluation, referral and case coordination. For information please call extension 304.

The Center on Dea@ess is dedicated to providing quality services for persons who are deaf or hard of hearing and their families, through educational, vocational, and residential services in a therapeutic, cornmuni&-based environment.

Accredited by the Joint Commission on Accreditation of Health Care Organizations

Client Privacy and Dignity

The Center on Deafness will ensure clients' right to confidentiality and privacy. Staff will at all times demonstrate respect for the clientJstudent right to confidentiality and be mindful of the need to maintain each individual's dignity. In order to ensure privacy every measure will be taken to avoid undignified displays during all aspects of client toileting, diapering and other activities of personal hygiene. Whenever possible bathroom doors will be closed and all diapering or changes of clothing will occur in private areas with or without staff as the individual need may dictate.

Staff will show respect for each individual in the manner in which they speak with them, care for them and talk about them.

Center on Deahess

Client Privacy and Dignity

The Center on Deafness will emure clients' right to confidentiality and privacy. Staff will at all times demonstrate respect for the client/student right to confidentiality and be mindful of the need to maintain each individual's dignity. In order to ensure privacy every measure will be taken to avoid undignified displays during all aspects of client toileting, diapering and other activities of personal hygiene. Whenever possible, bathroom doors will be closed and all diapering or changes of clothing will occur in private areas with or without staff as the individual need may dictate.

Staff will show respect for each individual in the manner in which they speak with them, care for them and talk about them.

Center on Deafness

enter Phone:847-559 -01 10

an 3444 Oundee R d , Northbrook 11 60062 TTY:847-559-9493 FAX:847-559-8199

eafness

OUR M/SS/O N

Center on Deafness is dedicated to providing quality services for persons who are deaf

or hard of hearing and their families, through educational, vocational, and residential

services in a therapeutic, community-based environment.

(Adopted by the Center on Deafness Management Team, October 1997)

OUR VALUES

1. We believe in the potential for growth of each individual.

2. We are dedicated to quality service to a unique population.

3. We take an educational I empowerment approach.

4. We respect the rights and confidentiality of our clients.

5 . We believe in the absolute need for a communicating environment.

(Adopted by the Center on Deafness Management Team, September. 1997.)

- 1 -

Init ial Renewal






TITLE E-MAIL ADDRESS Director [email protected]







02/11/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -


The applicant will obey all laws, regulations, and executive orders prohibiting discrimination on the basis of race, color, national origin, sex, age, or handicap and all other laws, regulations, and executive orders applicable to its activities, including but not limited to the School Code (105 ILCS 5/1-1 et seq.), Title IX of the Amendments of 1972 (20 U.S.C. 1681 et seq.), the Illinois Human Rights Act (775 ILCS 5/1-101 et seq.), the Individuals with Disabilities Education Act (20 U.S.C. 1400 et seq.), the Age Discrimination in Employment Act of 1967 (29 U.S.C. 621 et seq.), Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq., 2000e et seq.), the Public Works Employment Discrimination Act (775 ILCS 10/0.01 et seq.), and the Americans with Disabilities Act of 1990 (42 U.S.C.A. 12101 et seq.). Pursuant to Public Act 84-411, Illinois Criminal Background Checks have been conducted on the employees of this Program. Additionally, the undersigned certifies, under penalty of perjury, that he/she is not more than thirty (30) days delinquent in complying with a child support order; that failure to so certify may result in a denial of the renewal, and that making a false statement may subject the undersigned to contempt of court under 305 ILCS 5/10 – 17 – 6 of the Illinois Public Aid Code. I, the undersigned, attest that the information provided on and included with this application is accurate and true, that this Program is in compliance with applicable Rules and Regulations for Approval of Nonpublic Special Education Programs under Section 14-7.02 of the School Code of Illinois and agree that the Illinois State Board of Education has visitation rights to the above mentioned Program and may review the Program services to students for other statutory requirements under Section 14-7.02 of the School Code of Illinois. _Bonita Simon 04/13/2010

_Sarah Sebert



_____________________________________________________

Print Name

The following dates show when the program was updated: 7/12/2010 12/16/2010

- 3 -

ATTACHMENT A









(Minimum of 5 hours per day) 5.50 Summer School Session Begins (Enter Date*) 06/16/2011



49

Number of Instructional Hours per Day 5.50 Total Hours Summer Session (Min 120 Hours) 269.50


- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work


Group - 20

30

15

Art Therapy

Music Therapy

Nursing Individual - 15

Individual aides (indicate FTE) Individual -

Other (Specify):


1 15

12/16/2010 - 1 -




PERSONNEL RECORD





NAME TITLE IEIN NUMBER TIME TIME

Hrs/Wk Start

5 Days End







TITLE IEIN NUMBER TIME TIME Start 5 Days

End 5 Days

Length Vacant




07/19/10 David Wood Counselor 0 X

12/16/2010 - 2 -

ATTACHMENT D



PERSONNEL RECORD





DATE NAME Ability Ratio Range IEIN NUMBER TIME TIME Start

5 Days End




06/16/10 Tracy Weyhrauch SC D/HH 10:2 11-14 X

12/16/2010 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME

TITLE IEIN NUMBER TIME TIME Hrs/Wk

Start 5 Days

End 5 Days

Length Vacant

12/16/2010 - 1 -

ATTACHMENT F

PERSONNEL RECORD



START TERMINA- OTHER NECESSARY POSITION IEIN NUMBER FULL PART NOTICE DATE TION


5 Days End


11/29/10 Nikki Bonarirgo 1:1 Aide 0 X

10/25/10 Sam Kapacinskas 1:1 Aide 0 X

04/14/10 Michael Matzkin 1:1 Aide 0 X

12/16/2010 - 2 -



Heather Hollowell





Heidi Hondorp




Rena Lovell








12/16/2010 - 3 -

Bonita Simon




10 Special Teaching Endrs: Speech Correction 10 Special Teaching Endrs: Speech-Language Pathology


03 Elementary Teaching Endrs: Learning Disabilities 03 Elementary Teaching Endrs: Social/Emotional Disorders


09 Secondary Teaching Endrs: Learning Disabilities 09 Secondary Teaching Endrs: Social/Emotional Disorders

Tracy Weyhrauch Cert Code:39 Substitute-90 Days Teaching Registered through 2013







Michael Matzkin

David Wood Cert Desc:LPC Registered through 03/31/2011

Sam Kapacinskas

Nikki Bonarirgo

- 1 -

Init ial Renewal













02/11/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -



_Sarah Sebert



_____________________________________________________

Print Name


- 3 -

ATTACHMENT A












49



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work


Group - 20

30

15

Art Therapy

Music Therapy



Other (Specify):


1 15

12/16/2010 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant





12/16/2010 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End





12/16/2010 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

12/16/2010 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End





12/16/2010 - 2 -



Heather Hollowell





Heidi Hondorp




Rena Lovell








12/16/2010 - 3 -

Bonita Simon
















Michael Matzkin


Sam Kapacinskas

Nikki Bonarirgo

12/16/2010 Bonita Simon Centerview Therapeutic-Day 3444 Dundee Rd Northbrook, IL 60062 Dear Bonnie: Thank you for the updated information which has been received by our office. The following update(s) you provided have been reviewed and accepted. Personnel

Use copies of these forms when reporting future changes. You need only send copies of the pages with changes. Please remember to include copies of new licenses as well as the IEIN numbers for new staff members who have Illinois State Board of Education certification or approval.

Attached is a copy of the updated application for school years 2010-2012 reflecting your notifications to this office. Please review the revised form to ensure its overall accuracy and note any highlighted areas, if applicable. You may fax or mail any further changes to the Chicago office. The Chicago office fax is 312/814-8110. Please remember to include copies of any needed documentation. Should you have any questions, you may contact Sarah Sebert ([email protected]) at 312/814-3999 or Paul Nijensohn ([email protected]) at 312/814-2205. Sincerely

Sarah Sebert Principal Consultant Special Education Services

Illinois State Board of Education cc: Kathy Stratton, Illinois State Board of Education




Sarah Sebert Principal Consultant Special Education Services

Illinois State Board of Education cc: Kathy Stratton, Illinois State Board of Education

- 1 -

Init ial Renewal





under Section 14-7.02 of the School Code ELIGIBILITY WILL NOT BE GRANTED PRIOR TO THE DATE THIS APPLICATION IS APPROVED BY THE SPECIAL EDUCATION SERVICES DIVISION OF THE ILLINOIS STATE BOARD OF EDUCATION. Please consult 23 Illinois Administrative Code: 401 Nonpublic Special Education Programs for details. Complete all blanks or indicate that the information requested is not applicable. OFFICIAL NAME OF THE NONPUBLIC PROGRAM PHONE (Include Area Code) Centerview Therapeutic-Day (847) 559-0110 SITE ADMINISTRATOR FAX (Include Area Code) Rena Lovell (847) 559-8199




CHIEF EXECUTIVE OFFICER FAX (Include Area Code) Bonita Simon (847) 559-8199




11/15/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT

A. Intellectual I. Speech or Language Disability Impairment

C. Orthopedic X K. Emotional Impairment Disability 6-21


E. Visual X M. Multiple Impairment Disabilities 6-21

X F. Hearing N. Developmental Delay Impairment 6-21 (3 through 9 Years Old)



- 2 -



_Paul Nijensohn 05/01/2012



_____________________________________________________

Print Name

The following dates show when the program was updated: 7/12/2010 12/16/2010 2/3/2011 2/7/2011 3/22/2011 7/8/2011 3/12/2012 5/1/2012 8/22/2012 2/22/2013 3/7/2013 6/6/2013 7/10/2013 11/27/2013

- 3 -

ATTACHMENT A












49



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work


Group - 25

30

20

0

0

Art Therapy

Music Therapy



Other (Specify):

Psychiatric

1 19

11/27/2013 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant




11/27/2013 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End


06/01/13 Kelly Bridges SC D/HH ??? ??? X

09/03/13 Katherine Citti SC D/HH 10:2 X

11/27/2013 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

11/27/2013 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End


06/17/13 Don Arocho 1:1 Aide 0 X

09/03/13 Kathryn Haver 1:1 Aide 0 X


09/03/13 Tamara Zawacki Substitute X

11/27/2013 - 2 -



Simon Bonita



Endrs: Learning Behavior Specialist I - Grade 6 through Age 21


Endrs: Learning Disabilities - Grade 6 through Age 21

Endrs: Learning Disabilities - PreKindergarten though Grade 9

Endrs: Social/Emotional Disorders - Grade 6 through Age 21

Endrs: Social/Emotional Disorders - PreKindergarten though Grade 9



Endrs: Superintendent - Kindergarten through Grade 12

Lovell Rena


Endrs: Deaf & Hard Of Hearing - Supervising - PreKindergarten through Age 21






11/27/2013 - 3 -

Bridges Kelly



Citti Katherine



Zawacki Tamara



Endrs: Paraprofessional Educator - Kindergarten through Grade 12

11/27/2013 - 4 -

11/27/2013 - 5 -






Michael Matzkin


Don Arocho

Kathryn Haver

11/27/2013 - 6 -

November 27, 2013 Rena Lovell Centerview Therapeutic-Day 3444 Dundee Rd Northbrook, IL 60062 Dear Rena Lovell: Thank you for the updated information which has been received by our office. The following update(s) you provided have been reviewed and accepted. Personnel


Attached is a copy of the updated application for school years 2012-2014 reflecting your notifications to this office. Please review the revised form to ensure its overall accuracy and note any highlighted/bolded areas, if applicable, as this indicates any missing and/or expired information. You may fax or mail any further changes to the Chicago office. The Chicago office fax is 312/814-3171. Please remember to include copies of any needed documentation. If you have questions, please contact Heather Zeman at (312) 814-8251 or by email at [email protected]. Sincerely

Heather Zeman

Principal Consultant Special Education Services Illinois State Board of Education cc: Pam Solomon, Illinois State Board of Education

November 27, 2013 Rena Lovell Centerview Therapeutic-Day 3444 Dundee Rd Northbrook, IL 60062 Dear Rena Lovell: Thank you for the updated information which has been received by our office. The following update(s) you provided have been reviewed and accepted. Personnel


Attached is a copy of the updated application for school years 2012-2014 reflecting your notifications to this office. Please review the revised form to ensure its overall accuracy and note any highlighted/bolded areas, if applicable, as this indicates any missing and/or expired information. You may fax or mail any further changes to the Chicago office. The Chicago office fax is 312/814-3171. Please remember to include copies of any needed documentation. If you have questions, please contact Heather Zeman at (312) 814-8251 or by email at [email protected]. Sincerely

Heather Zeman Principal Consultant Special Education Services Illinois State Board of Education cc: Pam Solomon, Illinois State Board of Education

Printed by AFL-CIO (AFSCME Local #2811 and IFSOE Local #3236) Employees

M E M O R A N D U M TO: Approved Nonpublic Programs serving students under

Section 14-7.02 of the School Code of Illinois FROM: Sarah Sebert, Paul Nijensohn Principal Consultants, Department of Special Education DATE: 2009-2010 Renewal Time SUBJECTS: Notification to ISBE of Changes to Your Approved 2009-2010

Application Sarah Sebert is your program consultant. Sarah Sebert can be reached at (312) 814-5560 or (312) 814-5560 or by e-mail at [email protected] Notification to ISBE of Changes to Your Approved Application In accordance with 23 IAC 401.20, as information on the enclosed form changes, this office must be notified. Change notifications may be submitted by mail to: Sarah Sebert, ISBE 100 W. Randolph

Suite 4 -800 Chicago, IL. 60601 Or by fax to: (312) 814-8110

(If faxing, please DO NOT also send a hard copy) Thank you for your cooperation. Please contact us with any questions. Division of Special Education: Kathy Stratton (Support): (217) 782-5589 Paul Nijensohn (Principal Consultant): (312) 814-5560 or (312) 814-2205 Sarah Sebert (Principal Consultant): (312) 814-5560 or (312) 814-3999 Division of Funding and Disbursement: Satu Allen (Purchased Care Review Board): (217) 782-5256

Beth Burkhalter (Purchased Care Review Board): (217) 782-5256

October 9, 2009 Bonita Simon Director Centerview Therapeutic-Day 3444 Dundee Rd Northbrook, IL. 60062 Re: 2009-2010 Program Eligibility Dear Bonita Simon: The evaluation of the Application for Eligibility of Nonpublic Programs to Serve Students With Disabilities under Section 14-7.02 of the School Code submitted by your agency is complete. A copy of the approved application and all its required attachments is enclosed. In accordance with changes to 23 Illinois Administrative Code 401, your program has been granted approval for 2009-2010. Please note the situations on the reverse of this letter regarding maintenance of program eligibility status, especially notification of changes. If you have questions, please contact Sarah Sebert at (312) 814-5560. Thank you for your willingness to serve Illinois students with disabilities. Sincerely,

David Andel Division Administrator Division of Special Education Services

Requirements to Maintain Program Eligibility Status 1. Placement of each student with disabilities in a nonpublic program must be by

contractual agreement initiated by the public school district of residence, between the public school district and the nonpublic program, and in accordance with 23 Illinois Administrative Code 401, Special Education Facilities under Section 14-7.02 of the School Code and 23 Illinois Administrative Code 226, Special Education.

2. Before the contractual agreement may be initiated by the public school

district, it is necessary for the nonpublic program to secure an approved allowable cost rate for serving children with disabilities. Such approved allowable rates are secured according to procedures established by the Illinois Purchased Care Review Board. Applications for such costs must be made on the Consolidated Financial Report, provided by the Illinois Purchased Care Review Board. Contact for the Interagency Statistical and Financial Report may be made to:

Illinois State Board of Education Division of Funding and Disbursement Services 100 North First Street, E-320 Springfield, Illinois 62777-0001 (217) 782-5256 3. Any changes in personnel, program, or location or status of the physical facility in

which the program is conducted must be reported to the Illinois State Board of Education in accordance with 23 Illinois Administrative Code 401.20.

4. To maintain this status of program eligibility, the facility must remain in full

compliance with 23 Illinois Administrative Code 401, Special Education Facilities under Section 14-7.02 of the School Code and applicable parts of 23 Illinois Administrative Code 226, Special Education.

Further information may be obtained by contacting the Division of Special Education Services, telephone (217) 782-5589.

September 22, 2014 Rena Lovell Director Centerview Therapeutic 3444 Dundee Rd Northbrook, IL. 60062 Re: 2014-2016 Program Eligibility Dear Rena Lovell: The evaluation of the Application for Eligibility of Nonpublic Programs to Serve Students With Disabilities under Section 14-7.02 of the School Code submitted by your agency is complete. A copy of the approved application and all its required attachments is enclosed. In accordance with 23 Illinois Administrative Code 401, your program has been granted approval for 2014-2016. Please note the situations on the reverse of this letter regarding maintenance of program eligibility status, especially notification of changes. If you have questions, please contact Heather Zeman at (312) 814-8251 or by email at [email protected]. Thank you for your willingness to serve Illinois students with disabilities. Sincerely,


- 1 -

Init ial Renewal





under Section 14-7.02 of the School Code ELIGIBILITY WILL NOT BE GRANTED PRIOR TO THE DATE THIS APPLICATION IS APPROVED BY THE SPECIAL EDUCATION SERVICES DIVISION OF THE ILLINOIS STATE BOARD OF EDUCATION. Please consult 23 Illinois Administrative Code: 401 Nonpublic Special Education Programs for details. Complete all blanks or indicate that the information requested is not applicable. OFFICIAL NAME OF THE NONPUBLIC PROGRAM PHONE (Include Area Code) Centerview Therapeutic (847) 559-0110 SITE ADMINISTRATOR FAX (Include Area Code) Rena Lovell (847) 559-8199






THIS IS AN APPLICATION FOR: (Check One) (Check One) Educational Program Only X Co-educational Educational/Residential Program Combination Males Only X Residential Program Only Females Only RESIDENTIAL LICENSING AGENT (If Applicable)

State Agency Name Type of License Expiration Date

DCFS Group Home 09/08/2014


07/03/2012


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT




E. Visual X M. Multiple Impairment Disabilities 13-21 0


X G. Deafness O. Autism 13-21 0


- 2 -



_Heather Zeman 05/05/2014



_____________________________________________________

Print Name

The following dates show when the program was updated: 7/21/2010 8/10/2010 3/12/2012 5/1/2012 3/7/2013 3/12/2014 9/18/2014

- 3 -

ATTACHMENT A




NONPUBLIC PROGRAM INSTRUCTIONAL PROGRAM SCHEDULE FOR 2014-2015 Program Code 464 Program Code 543 Facility Name Centerview Therapeutic Regular School Year Begins (Enter Date*)



School Year (176 Minimum)


(Minimum of 5 hours per day) Summer School Session Begins (Enter Date*)

Summer School Session Closes (Enter Date*)




- 4 -





Centerview Therapeutic INSTRUCTIONS: Complete the following data as of April 1 of the current year. No other form will be accepted.



DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work

Counseling

Art Therapy

Music Therapy

Nursing


Other (Specify):

9/18/2014 - 1 -




PERSONNEL RECORD

From: April 15, 2011 Thru: _Present INSTRUCTIONS: FOLLOW INSTRUCTIONS ENCLOSED. NO OTHER FORM WILL BE ACCEPTED. PROGRAM: Centerview Therapeutic





Hrs/Wk Start

5 Days End






End 5 Days

Length Vacant

9/18/2014 - 2 -

ATTACHMENT D



PERSONNEL RECORD


INSTRUCTIONS: FOLLOW INSTRUCTIONS ENCLOSED. NO OTHER FORM WILL BE ACCEPTED. PROGRAM: Centerview Therapeutic




5 Days End


9/18/2014 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

9/18/2014 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End


9/18/2014 - 2 -



9/18/2014 - 3 -




8/22/2012 Bonita Simon Centerview Therapeutic-Day 3444 Dundee Rd Northbrook, IL 60062 Dear Bonita Simon: Thank you for the updated information which has been received by our office. The following update(s) you provided have been reviewed and accepted. Personnel


Attached is a copy of the updated application for school years 2012-2014 reflecting your notifications to this office. Please review the revised form to ensure its overall accuracy and note any highlighted/bolded areas, if applicable, as this indicates any missing and/or expired information. You may fax or mail any further changes to the Chicago office. The Chicago office fax is 312/814-8110. Please remember to include copies of any needed documentation. Should you have any questions, you may contact Heather Zeman ([email protected]) at 312/814-3999 or Paul Nijensohn ([email protected]) at 312/814-2205. Sincerely

Paul Nijensohn

Principal Consultant Special Education Services Illinois State Board of Education cc: Kathy Stratton, Illinois State Board of Education

- 1 -

Init ial Renewal













11/15/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT


C. Orthopedic X K. Emotional Impairment Disability 6-21 0






- 2 -






_____________________________________________________

Print Name

The following dates show when the program was updated: 7/12/2010 12/16/2010 2/3/2011 2/7/2011 3/22/2011 7/8/2011 3/12/2012 5/1/2012 8/22/2012

- 3 -

ATTACHMENT A












48



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work


Group - 25

30

20

0

0

Art Therapy

Music Therapy



Other (Specify):

Psychiatric

1 19

8/22/2012 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant





8/22/2012 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End




03/01/11 Erin Moran SC D/HH 2:1 7-8 X


8/22/2012 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

8/22/2012 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End


06/15/11 Kelly Bridges 1:1 Aide X


03/12/12 Abygail Peters 1:1 Aide X

03/13/12 Ricardo Ruiz 1:1 Aide 0 X

8/22/2012 - 2 -



Kelly Bridges

Cert Code:10 Special Teaching Registered through 2015


Heidi Herbon

Cert Code:03 Elementary Teaching Registered through 2016




Heather Hollowell








8/22/2012 - 3 -

Rena Lovell










Erin Moran



Abygail Peters


09 Secondary Teaching Endrs: Health Education


09 Secondary Teaching Endrs: Social Science

09 Secondary Teaching Endrs: Social Science-Psychology

8/22/2012 - 4 -

Bonita Simon















Tracy Weyhrauch


Cert Code:39 Substitute Teaching Registered through 2013

8/22/2012 - 5 -

8/22/2012 - 6 -







Michael Matzkin


Ricardo Ruiz

8/22/2012 - 7 -

8/10/2010 - 1 -

Init ial Renewal





under Section 14-7.02 of the School Code ELIGIBILITY WILL NOT BE GRANTED PRIOR TO THE DATE THIS APPLICATION IS APPROVED BY THE SPECIAL EDUCATION SERVICES DIVISION OF THE ILLINOIS STATE BOARD OF EDUCATION. Please consult 23 Illinois Administrative Code: 401 Nonpublic Special Education Programs for details. Complete all blanks or indicate that the information requested is not applicable. OFFICIAL NAME OF THE NONPUBLIC PROGRAM PHONE (Include Area Code) Centerview Therapeutic (847) 559-0110 SITE ADMINISTRATOR FAX (Include Area Code) Bonita Simon (847) 559-8199








DCFS


03/18/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








8/10/2010 - 2 -



_Sarah Sebert 07/21/2010



_____________________________________________________

Print Name


8/10/2010 - 3 -

8/10/2010 - 4 -

8/10/2010 - 1 -

Init ial Renewal













DCFS


03/18/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








8/10/2010 - 2 -






_____________________________________________________

Print Name


8/10/2010 - 3 -

8/10/2010 - 4 -




Application Sarah Sebert is your program consultant. Sarah Sebert can be reached at (312) 814-5560 or (312) 814-3999 or by e-mail at [email protected] Notification to ISBE of Changes to Your Approved Application In accordance with 23 IAC 401.20, as information on the enclosed form changes, this office must be notified. Change notifications may be submitted by mail to: Sarah Sebert, ISBE Chicago Office Chicago, IL. 60601 Or by fax to: (312) 814-8110



July 22, 2010 Bonita Simon Director Centerview Therapeutic 3444 Dundee Rd Northbrook, IL. 60062 Re: 2010-2012 Program Eligibility Dear Bonita Simon: The evaluation of the Application for Eligibility of Nonpublic Programs to Serve Students With Disabilities under Section 14-7.02 of the School Code submitted by your agency is complete. A copy of the approved application and all its required attachments is enclosed. In accordance with changes to 23 Illinois Administrative Code 401, your program has been granted approval for 2010-2012. Please note the situations on the reverse of this letter regarding maintenance of program eligibility status, especially notification of changes. If you have questions, please contact Sarah Sebert at (312) 814-3999. Thank you for your willingness to serve Illinois students with disabilities. Sincerely,


7/21/2010 - 1 -

Init ial Renewal













DCFS


03/18/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT

7/21/2010 - 2 -








7/21/2010 - 3 -






_____________________________________________________

Print Name

The following dates show when the program was updated: 7/21/2010

7/21/2010 - 4 -

7/21/2010 - 1 -

Init ial Renewal













DCFS


03/18/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT

7/21/2010 - 2 -








7/21/2010 - 3 -






_____________________________________________________

Print Name


7/21/2010 - 4 -

July 20, 2010 Bonita Simon Director Centerview Therapeutic-Day 3444 Dundee Rd Northbrook, IL. 60062 Re: 2010-2012 Program Eligibility Dear Bonita Simon: The evaluation of the Application for Eligibility of Nonpublic Programs to Serve Students With Disabilities under Section 14-7.02 of the School Code submitted by your agency is complete. A copy of the approved application and all its required attachments is enclosed. In accordance with changes to 23 Illinois Administrative Code 401, your program has been granted approval for 2010-2012. Next year at this time you will only be required to complete calendar information for the 2011-2012 school year. Directions for that will be sent to you, as before. Please note the situations on the reverse of this letter regarding maintenance of program eligibility status, especially notification of changes. If you have questions, please contact Sarah Sebert at (312) 814-3999. Thank you for your willingness to serve Illinois students with disabilities. Sincerely,


- 1 -

Init ial Renewal













02/11/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -






_____________________________________________________

Print Name


- 3 -

ATTACHMENT A












49



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work


Group - 20

30

15

Art Therapy

Music Therapy



Other (Specify):


1 15

7/12/2010 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant





7/12/2010 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End





7/12/2010 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

7/12/2010 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End


02/11/10 Jacqueline Eckstrom 1:1 Aide 0 X

01/11/10 Meghan Hardey 1:1 Aide 0 X



7/12/2010 - 2 -



Heather Hollowell





Heidi Hondorp




Rena Lovell








7/12/2010 - 3 -

Bonita Simon










7/12/2010 - 4 -








Brian Swatek

Michael Matzkin

Meghan Hardey

Jacqueline Eckstrom

- 1 -

Init ial Renewal













02/11/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -






_____________________________________________________

Print Name


- 3 -

ATTACHMENT A












49



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work


Group - 20

30

15

Art Therapy

Music Therapy



Other (Specify):


1 15

7/12/2010 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant





7/12/2010 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End





7/12/2010 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

7/12/2010 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End


02/11/10 Jacqueline Eckstrom 1:1 Aide 0 X

01/11/10 Meghan Hardey 1:1 Aide 0 X



7/12/2010 - 2 -



Heather Hollowell





Heidi Hondorp




Rena Lovell








7/12/2010 - 3 -

Bonita Simon










7/12/2010 - 4 -








Brian Swatek

Michael Matzkin

Meghan Hardey

Jacqueline Eckstrom

July 10, 2013 Rena Lovell Centerview Therapeutic-Day 3444 Dundee Rd Northbrook, IL 60062 Dear Rena Lovell: Thank you for the updated information which has been received by our office. The following update(s) you provided have been reviewed and accepted. Personnel


Attached is a copy of the updated application for school years 2012-2014 reflecting your notifications to this office. Please review the revised form to ensure its overall accuracy and note any highlighted/bolded areas, if applicable, as this indicates any missing and/or expired information. Please note that the program’s State Fire Marshal inspection is expired (11/15/10). If you have a more recent approved inspection, please provide a copy of that. If you need to request an inspection, the form can be found on our website which you may forward to me. You may fax or mail any further changes to the Chicago office. The Chicago office fax is 312/814-8110. Please remember to include copies of any needed documentation. If you have questions, please contact Paul Nijensohn at (312) 814-8246 or by email at [email protected]. Sincerely

Paul Nijensohn

Principal Consultant Special Education Services Illinois State Board of Education cc: Pam Solomon, Illinois State Board of Education

- 1 -

Init ial Renewal













11/15/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -






_____________________________________________________

Print Name

The following dates show when the program was updated: 7/12/2010 12/16/2010 2/3/2011 2/7/2011 3/22/2011 7/8/2011 3/12/2012 5/1/2012 8/22/2012 2/22/2013 3/7/2013 6/6/2013 7/10/2013

- 3 -

ATTACHMENT A












49



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work


Group - 25

30

20

0

0

Art Therapy

Music Therapy



Other (Specify):

Psychiatric

1 19

7/10/2013 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant




7/10/2013 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End





7/10/2013 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

7/10/2013 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End





7/10/2013 - 2 -



Kelly Bridges



Rena Lovell










Erin Moran



7/10/2013 - 3 -

Abygail Peters




09 Secondary Teaching Endrs: Physical Education



Bonita Simon















7/10/2013 - 4 -

Tracy Weyhrauch



7/10/2013 - 5 -






Michael Matzkin


Don Arocho

7/10/2013 - 6 -

7/8/2011 Bonita Simon Centerview Therapeutic-Day 3444 Dundee Rd Northbrook, IL 60062 Dear Bonnie: Thank you for the updated information which were received by our office on May 11 and June 10. The following update(s) you provided have been reviewed. Personnel

Use copies of these forms when reporting future changes. You need only send copies of the pages with changes. Please remember to include copies of new licenses as well as the IEIN numbers for new staff members who have Illinois State Board of Education certification or approval. Please note that Heather H. certificate was never registered, Rena L. certificate expired in 2006 and one of the other teachers’ certificate expired at the end of June, 2011. These all need to be registered/re-registered.

Attached is a copy of the updated application for school years 2011-2012 reflecting your notifications to this office. Please review the revised form to ensure its overall accuracy and note any highlighted areas, if applicable. You may fax or mail any further changes to the Chicago office. The Chicago office fax is 312/814-8110. Should you have any questions, you may contact Sarah Sebert ([email protected]) at 312/814-3999 or Paul Nijensohn ([email protected]) at 312/814-2205. Sincerely

Sarah Sebert Principal Consultant Special Education Services Illinois State Board of Education cc: Kathy Stratton, Illinois State Board of Education

7/8/2011 Bonita Simon Centerview Therapeutic-Day 3444 Dundee Rd Northbrook, IL 60062 Dear Bonnie: Thank you for the updated information which were received by our office on May 11 and June 10. The following update(s) you provided have been reviewed. Personnel

Use copies of these forms when reporting future changes. You need only send copies of the pages with changes. Please remember to include copies of new licenses as well as the IEIN numbers for new staff members who have Illinois State Board of Education certification or approval. Please note that Heather H. certificate was never registered, Rena L. certificate expired in 2006 and one of the other teachers’ certificate expired at the end of June, 2011. These all need to be registered/re-registered.

Attached is a copy of the updated application for school years 2011-2012 reflecting your notifications to this office. Please review the revised form to ensure its overall accuracy and note any highlighted areas, if applicable. You may fax or mail any further changes to the Chicago office. The Chicago office fax is 312/814-8110. Should you have any questions, you may contact Sarah Sebert ([email protected]) at 312/814-3999 or Paul Nijensohn ([email protected]) at 312/814-2205. Sincerely

Sarah Sebert


- 1 -

Init ial Renewal









CHIEF EXECUTIVE OFFICER FAX (Include Area Code) Robert Van Dyke (847) 559-8199




02/11/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -



_Sarah Sebert



_____________________________________________________

Print Name

The following dates show when the program was updated: 7/12/2010 12/16/2010 2/3/2011 2/7/2011 3/22/2011 7/8/2011

- 3 -

ATTACHMENT A












49



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work


Group - 20

30

15

Art Therapy

Music Therapy



Other (Specify):


1 15

7/8/2011 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant





7/8/2011 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End






7/8/2011 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

7/8/2011 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End


06/15/11 Kelly Bridges 1:1 Aide 0 X

03/14/11 Alyssa Giliberto 1:1 Aide 0 X


7/8/2011 - 2 -



Heidi Herbon





Heather Hollowell





Rena Lovell










Erin Moran Cert Code:10 Special Teaching Registered through 2014


7/8/2011 - 3 -

Bonita Simon





75 Administrative Endrs: General Administrative 75 Administrative Endrs: Superintendent






Tracy Weyhrauch Cert Code:10 Special Teaching Registered through 2013

Cert Code:39 Substitute-90 Days Teaching Registered through 2013







Michael Matzkin

Kelly Bridges

Alyssa Giliberto


- 1 -

Init ial Renewal













02/11/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -



_Sarah Sebert



_____________________________________________________

Print Name


- 3 -

ATTACHMENT A












49



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work


Group - 20

30

15

Art Therapy

Music Therapy



Other (Specify):


1 15

7/8/2011 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant





7/8/2011 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End






7/8/2011 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

7/8/2011 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End





7/8/2011 - 2 -



Heidi Herbon





Heather Hollowell





Rena Lovell












7/8/2011 - 3 -

Bonita Simon





75 Administrative Endrs: General Administrative 75 Administrative Endrs: Superintendent














Michael Matzkin

Kelly Bridges

Alyssa Giliberto




Attached is a copy of the updated application for school years 2012-2014 reflecting your notifications to this office. Please review the revised form to ensure its overall accuracy and note any highlighted/bolded areas, if applicable, as this indicates any missing and/or expired information. Please be aware that I show the facility’s most recent State Fire Marshal inspection as 11/15/2010. This exceeds the 24 month approval. Please submit your request for an inspection immediately. You may fax or mail any further changes to the Chicago office. The Chicago office fax is 312/814-8110. Please remember to include copies of any needed documentation. Should you have any questions, you may contact Paul Nijensohn ([email protected]) at 312/814-8246. Sincerely




Attached is a copy of the updated application for school years 2012-2014 reflecting your notifications to this office. Please review the revised form to ensure its overall accuracy and note any highlighted/bolded areas, if applicable, as this indicates any missing and/or expired information. Please be aware that I show the facility’s most recent State Fire Marshal inspection as 11/15/2010. This exceeds the 24 month approval. Please submit your request for an inspection immediately. You may fax or mail any further changes to the Chicago office. The Chicago office fax is 312/814-8110. Please remember to include copies of any needed documentation. Should you have any questions, you may contact Paul Nijensohn ([email protected]) at 312/814-8246. Sincerely

Paul Nijensohn Principal Consultant Special Education Services Illinois State Board of Education cc: Kathy Stratton, Illinois State Board of Education

- 1 -

Init ial Renewal













11/15/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -






_____________________________________________________

Print Name

The following dates show when the program was updated: 7/12/2010 12/16/2010 2/3/2011 2/7/2011 3/22/2011 7/8/2011 3/12/2012 5/1/2012 8/22/2012 2/22/2013 3/7/2013 6/6/2013

- 3 -

ATTACHMENT A












49



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work


Group - 25

30

20

0

0

Art Therapy

Music Therapy



Other (Specify):

Psychiatric

1 19

6/6/2013 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant





6/6/2013 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End






6/6/2013 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

6/6/2013 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End






6/6/2013 - 2 -



Kelly Bridges



Heidi Herbon





Aprv:Learning Behavior Specialist I

Heather Hollowell








6/6/2013 - 3 -

Rena Lovell










Erin Moran



Abygail Peters




09 Secondary Teaching Endrs: Physical Education



6/6/2013 - 4 -

Bonita Simon















Tracy Weyhrauch



6/6/2013 - 5 -

6/6/2013 - 6 -






Mark Hagler Cert Desc:LCPC Registered through 03/31/2015

Michael Matzkin


Ricardo Ruiz

6/6/2013 - 7 -

May 9, 2014 Rena Lovell Director Centerview Therapeutic-Day 3444 Dundee Rd Northbrook, IL. 60062 Re: 2014-2016 Program Eligibility Dear Rena Lovell: The evaluation of the Application for Eligibility of Nonpublic Programs to Serve Students With Disabilities under Section 14-7.02 of the School Code submitted by your agency is complete. A copy of the approved application and all its required attachments is enclosed. In accordance with 23 Illinois Administrative Code 401, your program has been granted approval for 2014-2016. Next year at this time you will only be required to complete calendar information for the 2015-2016 school year. Directions for that will be sent to you, as before. Please note the situations on the reverse of this letter regarding maintenance of program eligibility status, especially notification of changes. If you have questions, please contact Heather Zeman at (312) 814-8251 or by email at [email protected]. Thank you for your willingness to serve Illinois students with disabilities. Sincerely,


- 1 -

Init ial Renewal













07/03/2012


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -



_Heather Zeman 05/05/2014



_____________________________________________________

Print Name

The following dates show when the program was updated: 7/12/2010 12/16/2010 2/3/2011 2/7/2011 3/22/2011 7/8/2011 3/12/2012 5/1/2012 8/22/2012 2/22/2013 3/7/2013 6/6/2013 7/10/2013 11/27/2013 3/12/2014 5/5/2014

- 3 -

ATTACHMENT A









(Minimum of 5 hours per day) .00 Summer School Session Begins (Enter Date*) 06/15/2015



49



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work

Counseling Individual - 7 14

Art Therapy

Music Therapy

Nursing Individual - 4 14


Other (Specify):

Psychiatric

52 14

5/5/2014 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant




5/5/2014 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End


06/01/13 Kelly Bridges SC D/HH 10:2 13-17 X

09/03/13 Katherine Citti SC D/HH 10:2 17-20 X

5/5/2014 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

5/5/2014 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End




05/05/14 Monet Wyche 1:1 Aide 0 X


5/5/2014 - 2 -



Simon Bonita







Endrs: Secondary Education - Grade 6 through Grade 12






Lovell Rena








5/5/2014 - 3 -

Bridges Kelly



Citti Katherine



Zawacki Tamara




5/5/2014 - 4 -

5/5/2014 - 5 -






Michael Matzkin


Kathryn Haver

Monet Wyche

5/5/2014 - 6 -



Section 14-7.02 of the School Code of Illinois FROM: Paul Nijensohn Principal Consultants, Department of Special Education DATE: 2012-2014 Renewal Time SUBJECTS: Notification to ISBE of Changes to Your Approved 2012-2014

Application Paul Nijensohn is your program consultant. Paul Nijensohn can be reached at (312) 814-5560 or (312) 814-2205 or by e-mail at [email protected] Notification to ISBE of Changes to Your Approved Application In accordance with 23 IAC 401.20, as information on the enclosed form changes, this office must be notified. Change notifications may be submitted by mail to: Paul Nijensohn, ISBE Chicago Office Chicago, IL. 60601 Or by fax to: (312) 814-8110

(If faxing, please DO NOT also send a hard copy) Thank you for your cooperation. Please contact us with any questions. Division of Special Education: Kathy Stratton (Support): (217) 782-5589 Paul Nijensohn (Principal Consultant): (312) 814-5560 or (312) 814-2205 Division of Funding and Disbursement: Satu Allen (Purchased Care Review Board): (217) 782-5256

Lauren Russell (Purchased Care Review Board): (217) 782-5256

May 4, 2012 Bonita Simon Director Centerview Therapeutic-Day 3444 Dundee Rd Northbrook, IL. 60062 Re: 2012-2014 Program Eligibility Dear Bonita Simon: The evaluation of the Application for Eligibility of Nonpublic Programs to Serve Students With Disabilities under Section 14-7.02 of the School Code submitted by your agency is complete. A copy of the approved application and all its required attachments is enclosed. In accordance with 23 Illinois Administrative Code 401, your program has been granted approval for 2012-2014. Next year at this time you will only be required to complete calendar information for the 2013-2014 school year. Directions for that will be sent to you, as before. Please note the situations on the reverse of this letter regarding maintenance of program eligibility status, especially notification of changes. If you have questions, please contact Paul Nijensohn at (312) 814-2205. Thank you for your willingness to serve Illinois students with disabilities. Sincerely,


May 4, 2012 Bonita Simon Director Centerview Therapeutic 3444 Dundee Rd Northbrook, IL. 60062 Re: 2012-2014 Program Eligibility Dear Bonita Simon: The evaluation of the Application for Eligibility of Nonpublic Programs to Serve Students With Disabilities under Section 14-7.02 of the School Code submitted by your agency is complete. A copy of the approved application and all its required attachments is enclosed. In accordance with 23 Illinois Administrative Code 401, your program has been granted approval for 2012-2014. Please note the situations on the reverse of this letter regarding maintenance of program eligibility status, especially notification of changes. If you have questions, please contact Paul Nijensohn at (312) 814-2205. Thank you for your willingness to serve Illinois students with disabilities. Sincerely,


May 4, 2012 Bonita Simon Director Centerview Therapeutic-Day 3444 Dundee Rd Northbrook, IL. 60062 Re: 2012-2014 Program Eligibility Dear Bonita Simon: The evaluation of the Application for Eligibility of Nonpublic Programs to Serve Students With Disabilities under Section 14-7.02 of the School Code submitted by your agency is complete. A copy of the approved application and all its required attachments is enclosed. In accordance with 23 Illinois Administrative Code 401, your program has been granted approval for 2012-2014. Next year at this time you will only be required to complete calendar information for the 2013-2014 school year. Directions for that will be sent to you, as before. Please note the situations on the reverse of this letter regarding maintenance of program eligibility status, especially notification of changes. If you have questions, please contact Paul Nijensohn at (312) 814-2205. Thank you for your willingness to serve Illinois students with disabilities. Sincerely,


May 4, 2012 Bonita Simon Director Centerview Therapeutic 3444 Dundee Rd Northbrook, IL. 60062 Re: 2012-2014 Program Eligibility Dear Bonita Simon: The evaluation of the Application for Eligibility of Nonpublic Programs to Serve Students With Disabilities under Section 14-7.02 of the School Code submitted by your agency is complete. A copy of the approved application and all its required attachments is enclosed. In accordance with 23 Illinois Administrative Code 401, your program has been granted approval for 2012-2014. Please note the situations on the reverse of this letter regarding maintenance of program eligibility status, especially notification of changes. If you have questions, please contact Paul Nijensohn at (312) 814-2205. Thank you for your willingness to serve Illinois students with disabilities. Sincerely,


- 1 -

Init ial Renewal













11/15/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -






_____________________________________________________

Print Name

The following dates show when the program was updated: 7/12/2010 12/16/2010 2/3/2011 2/7/2011 3/22/2011 7/8/2011 3/12/2012 5/1/2012

- 3 -

ATTACHMENT A












48



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work


Group - 25

30

20

0

0

Art Therapy

Music Therapy



Other (Specify):

Psychiatric

1 19

5/1/2012 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant





5/1/2012 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End






5/1/2012 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

5/1/2012 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End






5/1/2012 - 2 -



Kelly Bridges



Heidi Herbon





Heather Hollowell








5/1/2012 - 3 -

Rena Lovell










Erin Moran



Abygail Peters






5/1/2012 - 4 -

Bonita Simon















Tracy Weyhrauch



5/1/2012 - 5 -

5/1/2012 - 6 -







Michael Matzkin


Ricardo Ruiz

5/1/2012 - 7 -

- 1 -

Init ial Renewal















11/15/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -






_____________________________________________________

Print Name

The following dates show when the program was updated: 7/21/2010 8/10/2010 3/12/2012 5/1/2012

- 3 -

ATTACHMENT A














- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work

Counseling

Art Therapy

Music Therapy

Nursing


Other (Specify):

5/1/2012 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End






End 5 Days

Length Vacant

5/1/2012 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End


5/1/2012 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

5/1/2012 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End


5/1/2012 - 2 -



5/1/2012 - 3 -




M E M O R A N D U M TO: All programs currently approved under Section 14-7.02 of the School Code

of Illinois for school years 2010-2012 FROM: David Andel, Division Administrator Special Education Services – Springfield Division DATE: March 2011 SUBJECT: Reminder for submission of any changes Calendar submission for 2011-2012 Your program was approved last year for the 2010-2012 school year. Attached you will find instructions for completing the Nonpublic Program School Calendar for 2011-2012. Please submit the calendar to Kathy Stratton via email at [email protected]. If you have any questions regarding the calendar, please contact Kathy at (217) 782-5589. It is important that we continue to have accurate and current information about your program. At this time, please review the last approved application that was sent to you and make any needed updates/corrections. If you have any questions regarding the application, please contact Sarah Sebert at (312) 814-3999 or [email protected]. Mail or fax change notifications to:

Sarah Sebert Illinois State Board of Education,

Special Education 100 West Randolph

Suite 4-800 Chicago, Illinois 60601

(312) 814-8110 (fax)

Instructions for completing the Nonpublic Special Education Program School Calendar for 2011-2012

Each nonpublic program seeking approval from the Illinois State Board of Education and a rate set by the Illinois Purchased Care Review Board must submit a school calendar detailing days in session for the program. The rate-setting process and publication of the nonpublic school approvals is dependent upon timely receipt of these calendars. The 2011-2012 calendar is available on our website and may be accessed by going to: http://www.isbe.net/spec-ed/html/nonpublic_se.htm You may save the file in Excel by pointing to “2011-2012 Calendar”, right-click, then choose ‘Save Target As’. Name your excel file, complete the calendar per the directions below, and email your saved document to Kathy Stratton at [email protected] by April 15, 2011. Note: If you attach the calendar to an email, Ms. Stratton is able to send a receipt and approval via return email. Fax copies are usually not legible so will not be accepted. Below are instructions regarding the completion of the calendar.

1. A calendar must be submitted for every nonpublic school program. List all program codes that have been included on the application for approval.

2. Enter the name of the operating agency and nonpublic program as it appears on the

application.

3. Indicate all full days of student attendance (minimum of 5.0 clock hours) during the regular school year with X; indicate all half days of student attendance during the regular school year with 1/2X.

4. Indicate all full student attendance days during the summer session with S; indicate all half

days of student attendance during the summer session with 1/2S.

5. Indicate all school holidays recognized by your program with HOL.

6. Indicate all other days that students are NOT in attendance with NIA. Please note that weekend days have already been deleted from the calendar.

7. Enter the beginning and closing dates of both the regular school year and summer session

in the spaces provided in the lower right-hand corner of the calendar. Each beginning and closing date must be a student attendance day.

8. The spreadsheet will total your days as entered for each month and will compute the totals

for the attendance days, holidays (HOL), and not in attendance (NIA) days at the bottom right-hand side of the form.

9. Enter the name of the person completing the form, the date, phone and fax numbers, and

email address.

10. Check the box for proposed calendar. Subsequent to the initial calendar submission, any calendar amendments must be received no later than June 1, 2012, and should be identified by a check in the amended calendar box.


of Illinois for school years 2010-2012 FROM: David Andel, Division Administrator Special Education Services – Springfield Division DATE: March 2011 SUBJECT: Reminder for submission of any changes Calendar submission for 2011-2012 Your program was approved last year for the 2010-2012 school year. Attached you will find instructions for completing the Nonpublic Program School Calendar for 2011-2012. Please submit the calendar to Kathy Stratton via email at [email protected]. If you have any questions regarding the calendar, please contact Kathy at (217) 782-5589. It is important that we continue to have accurate and current information about your program. At this time, please review the last approved application that was sent to you and make any needed updates/corrections. If you have any questions regarding the application, please contact Sarah Sebert at (312) 814-3999 or [email protected]. Mail or fax change notifications to:

Sarah Sebert Illinois State Board of Education,



(312) 814-8110 (fax)





application.











email address.


- 1 -

Init ial Renewal













04/11/2008


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -


The applicant will obey all laws, regulations, and executive orders prohibiting discrimination on the basis of race, color, national origin, sex, age, or handicap and all other laws, regulations, and executive orders applicable to its activities, including but not limited to the School Code (105 ILCS 5/1-1 et seq.), Title IX of the Amendments of 1972 (20 U.S.C. 1681 et seq.), the Illinois Human Rights Act (775 ILCS 5/1-101 et seq.), the Individuals with Disabilities Education Act (20 U.S.C. 1400 et seq.), the Age Discrimination in Employment Act of 1967 (29 U.S.C. 621 et seq.), Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq., 2000e et seq.), the Public Works Employment Discrimination Act (775 ILCS 10/0.01 et seq.), and the Americans with Disabilities Act of 1990 (42 U.S.C.A. 12101 et seq.). Pursuant to Public Act 84-411, Illinois Criminal Background Checks have been conducted on the employees of this Program. Additionally, the undersigned certifies, under penalty of perjury, that he/she is not more than thirty (30) days delinquent in complying with a child support order; that failure to so certify may result in a denial of the renewal, and that making a false statement may subject the undersigned to contempt of court under 305 ILCS 5/10 – 17 – 6 of the Illinois Public Aid Code. I, the undersigned, attest that the information provided on and included with this application is accurate and true, that this Program is in compliance with applicable Rules and Regulations for Approval of Nonpublic Special Education Programs under Section 14-7.02 of the School Code of Illinois and agree that the Illinois State Board of Education has visitation rights to the above mentioned Program and may review the Program services to students for other statutory requirements under Section 14-7.02 of the School Code of Illinois. _ ____________________________________________________

_____________________________________________________



_____________________________________________________

Print Name


- 3 -

ATTACHMENT A












49



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work

Counseling

Art Therapy

Music Therapy

Nursing


Other (Specify):

3/16/2010 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant





3/16/2010 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End




09/02/09 David Wood SC D/HH 6:2 11-15 X

3/16/2010 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

3/16/2010 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End


10/08/07 Tom Bloodworth Aide 0 X

08/21/06 Michael Matzkin Aide 0 X

11/15/80 Judy Roin Nursing Assistant 0 X


3/16/2010 - 2 -



Heather Hollowell





Heidi Hondorp




Rena Lovell








3/16/2010 - 3 -

Bonita Simon












David Wood Cert Code:39 Substitute-90 Days Teaching Registered through 2010

3/16/2010 - 4 -

3/16/2010 - 5 -








Judy Roin

Tom Bloodworth

Michael Matzkin

Brian Swatek

3/16/2010 - 6 -




Sarah Sebert


- 1 -

Init ial Renewal













02/11/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -



_Sarah Sebert



_____________________________________________________

Print Name

The following dates show when the program was updated: 7/12/2010 12/16/2010 2/3/2011 2/7/2011 3/22/2011

- 3 -

ATTACHMENT A












49



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work


Group - 20

30

15

Art Therapy

Music Therapy



Other (Specify):


1 15

3/25/2011 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant





3/25/2011 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End






3/25/2011 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

3/25/2011 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End





3/25/2011 - 2 -



Heather Hollowell






Heidi Hondorp





Rena Lovell












3/25/2011 - 3 -

Bonita Simon




















Michael Matzkin

Alyssa Giliberto


- 1 -

Init ial Renewal













02/11/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -



_Sarah Sebert



_____________________________________________________

Print Name


- 3 -

ATTACHMENT A












49



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work


Group - 20

30

15

Art Therapy

Music Therapy



Other (Specify):


1 15

3/25/2011 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant





3/25/2011 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End






3/25/2011 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

3/25/2011 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End





3/25/2011 - 2 -



Heather Hollowell






Heidi Hondorp





Rena Lovell












3/25/2011 - 3 -

Bonita Simon




















Michael Matzkin

Alyssa Giliberto



of Illinois for school years 2012-2014 FROM: David Andel, Division Administrator Special Education Services – Springfield Division DATE: March 2013 SUBJECT: Reminder for submission of any changes Calendar submission for 2013-2014 Your program was approved last year for the 2012-2014 school year. Attached you will find instructions for completing the Nonpublic Program School Calendar for 2013-2014. Please submit the calendar to Kathy Stratton via email at [email protected]. If you have any questions regarding the calendar, please contact Kathy at (217) 782-5589. It is important that we continue to have accurate and current information about your program. At this time, please review the enclosed approved application and make any needed updates/corrections. If you have any questions regarding the application, please contact Paul Nijensohn at (312)-814-5560 or [email protected]. Mail or fax change notifications to:

Paul Nijensohn Illinois State Board of Education,



(312) 814-8110 (fax)





application.











email address.



of Illinois for school years 2012-2014 FROM: David Andel, Division Administrator Special Education Services – Springfield Division DATE: March 2013 SUBJECT: Reminder for submission of any changes Calendar submission for 2013-2014 Your program was approved last year for the 2012-2014 school year. Attached you will find instructions for completing the Nonpublic Program School Calendar for 2013-2014. Please submit the calendar to Kathy Stratton via email at [email protected]. If you have any questions regarding the calendar, please contact Kathy at (217) 782-5589. It is important that we continue to have accurate and current information about your program. At this time, please review the enclosed approved application and make any needed updates/corrections. If you have any questions regarding the application, please contact Paul Nijensohn at (312)-814-5560 or [email protected]. Mail or fax change notifications to:

Paul Nijensohn Illinois State Board of Education,



(312) 814-8110 (fax)





application.











email address.


- 1 -

Init ial Renewal


100 West Randolph Street Suite 4-800

Chicago, Illinois 60601-3223 Program Code 464 Program Code 543












07/03/2012


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -



_Viver Ballard 03/20/2015



_____________________________________________________

Print Name

The following dates show when the program was updated: 7/21/2010 8/10/2010 3/12/2012 5/1/2012 3/7/2013 3/12/2014 9/18/2014 3/20/2015

- 3 -

ATTACHMENT A



Chicago, Illinois 60601-3223











- 4 -





Centerview Therapeutic INSTRUCTIONS:


be provided directly by a public school district) 3. If group services are indicated on IEPs, please note the amount of therapist time that will be needed. Example: If 3 students receive

30 minutes of group speech services and are provided that service in 1 group, indicate 30 minutes total (therapist time needed) not 90. 4. Divide by 60. Enter total number of IEP-specified direct service hours and minutes on this form. 5. Total the number of students requiring IEP-specified consultative services in each related service area and enter that number in the

consult column. 6. Total the number of students requiring an individual aide that is specified on the IEP.

DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work

Counseling

Art Therapy

Music Therapy

Nursing

Other (Specify):

Individual aides

3/20/2015 - 1 -

ATTACHMENT C ATTACHMENT D




PERSONNEL RECORD






Hrs/Wk Start

5 Days End






End 5 Days

Length Vacant

3/20/2015 - 2 -

ATTACHMENT D ILLINOIS STATE BOARD OF EDUCATION

Special Education Services Division 100 West Randolph Street

Suite 4-800 Chicago, Illinois 60601-3223

PERSONNEL RECORD






5 Days End


3/20/2015 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

3/20/2015 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End


3/20/2015 - 2 -



3/20/2015 - 3 -




M E M O R A N D U M TO: All residential programs seeking renewal of approval under Section 14-7.02 of the School Code of

Illinois FROM David Andel, Division Administrator

Special Education Services DATE: March 2014 SUBJECT: 2014-2016 Renewal Applications for Residential Programs The procedure for renewal of applications to serve students (residential only) under Section 14-7.02 of the School Code of Illinois for the 2014-2016 school years is as follows: 1. Carefully review all typed information on the first two pages of the application and submit any

changes/updates, with any needed documentation. 2. Sign and date the second page. 3. Illinois Programs- If your Illinois State Fire Marshal inspection report is over 24 months old and you have

not had a more recent inspection, go to: http://webapps.sfm.illinois.gov/fprequest. Complete the form and submit it to the Office of the State Fire Marshal. Your application CANNOT be approved without a current, violation-free report from the State Fire Marshal.

4. Out-of-state Programs- The fire inspection report from a governmental entity must also be within the last

24 months. 5. Residential licensing must be current. If the date shown on page one (1) of the application is expired,

provide a copy of the current, valid license. 6. Out of State Programs: Please note that the public school district your students attend MUST submit a

calendar. The calendar and instructions can be found at http://www.isbe.net/spec-ed/html/nonpublic_se.htm.

7. In accordance with statutory requirements, you must submit your application for renewal by April 15,

2014. Mail to:

Pam Solomon

Illinois State Board of Education Division of Special Education Services

100 West Randolph Suite 4-800

Chicago, IL 60601 If you have questions, please contact Heather Zeman at (312) 814-8251 or by email at [email protected].

Illinois State Board of Education100 North First Street • Springfield, Illinois 62777-0001 Jesse H. Ruiz www.isbe.net Chairman Rod Blagojevich Christopher A. Koch, Ed.D. Governor State Superintendent of Education

M E M O R A N D U M TO: All programs seeking renewal of approval under Section 14-7.02 of the School

Code of Illinois FROM: David Andel, Division Administrator Special Education Services – Springfield Division DATE: March 2010 SUBJECT: 2010-2012 Renewal Applications for Education and Residential/Education

Combination programs Your program’s two-year renewal will expire at the end of the current school year. The procedure for renewal of applications to serve students under Section 14-7.02 of the School Code of Illinois for the 2010-2012 school year(s) is as follows:

1. Use these forms as your renewal application. These forms have been updated with information regarding changes that you have submitted to this office since your last approval.

2. Carefully review all typed information on the first two pages of the application and submit any changes/updates.

3. Sign and date the second page.

4. Complete Attachments A (Program Schedule) and B (Summary of Related Services) that are enclosed. Please READ AND FOLLOW the directions regarding the completion of the Related Services page.

5. Review all typed information on Attachments C – F (Personnel) and submit any

changes/updates.

NOTE: We have reviewed the information that is on file and have bolded areas where required information is missing, expired, or for which there are other questions/concerns. Your application will not be processed unless these areas are addressed. If you have questions, please call (312) 814-5560 or e-mail one of the consultants.

6. Illinois Programs - If your Illinois State Fire Marshal inspection report is over 24 months old and you have not had a more recent inspection, go to: http://www.isbe.net/spec-ed/word/fire_inspection_memo.doc. Complete the form and e-mail or fax it to us and we will forward it to the Office of the State Fire Marshal. Your application CANNOT be approved without a current report from the State Fire Marshal.

7. Out-of-state programs - Your fire inspection report from your governmental entity must also be within the last 24 months.

8. Complete your calendar for the 2010-2011 school year. See attached memo for

instructions.

9. If your program is approved to provide residential services, please make sure the license is current.

10. In accordance with statutory requirements, you must submit your application for renewal

by April 15, 2010. Mail to:

Kathy Stratton Illinois State Board of Education

Special Education Services Division N-253 100 North First Street

Springfield, IL 62777-0001

If you have questions, please contact Ms. Kathy Stratton at (217) 782-5589 ([email protected]), Paul Nijensohn at (312) 814-2205 ([email protected]) or Sarah Sebert at (312) 814-3999 ([email protected]).

Please use the attached checklist to assure that your application for renewed approval

contains all required information and is therefore immediately approvable.

Incomplete submissions will delay the process, delay the setting of your rate for 2010-2011,

and may result in a change of approval status to “Approved with Administrative Review.”


Call or e-mail your consultant if you do not understand an item:

Paul Nijensohn (312) 814-2205, [email protected] Sarah Sebert (312) 814-3999, [email protected]

PLEASE SIGN AND RETURN THIS PAGE WITH YOUR RENEWAL APPLICATION

___Incorrect identifying information (address/phone/e-mail/administrator name, etc) at the top of the cover page has been changed, if applicable. ___The State Fire Marshal inspection is not over 24 months old or a more recent one is included or has been requested. ___If categories or ages of approval have been changed, a revised program description requesting the change is included, or there are no changes from the previous approval. ___There are sufficient properly certified special education teachers and assistants (not including substitutes) to meet at least the 1:5 or 2:10 ratio of staff to enrolled students. ___Related service personnel are sufficient to meet the IEP needs listed on the Summary of Related Services page. Only related services to be provided by your program are listed. ___Related services are listed in individual hours and minutes or indicated as group hours and minutes. Consult services are only listed if indicated on the IEPs. ___The application is signed (original signature required). ___IEIN #s for all teaching certificates and paraprofessional statements of approval as well as any professional licenses are included for all new personnel or for those whose IEIN #s had not been previously submitted. ___Any changes of staff time include dates as to when the changes occurred and staff listed as terminated or newly hired include dates as to when the changes took place.

ALL BOLDED AND HIGHLIGHTED AREAS HAVE BEEN ADDRESSED _______________________________ ________________________ Signature Phone number


Each nonpublic program seeking approval from the Illinois State Board of Education and a rate set by the Illinois Purchased Care Review Board must submit a school calendar detailing days in session for the program. The rate-setting process and publication of the nonpublic school approvals is dependent upon timely receipt of these calendars. The 2010-2011 calendar is available on our website and may be accessed by going to: http://www.isbe.net/spec-ed/html/nonpublic_se.htm.. You may save the file in Excel by pointing to 2010-2011 Calendar”, right-click, then choose ‘Save Target As’. Name your excel file, complete the calendar per the directions below, and email your saved document to Kathy Stratton at [email protected] by April 15, 2010. Note: if you attach the calendar to an email, Ms. Stratton is able to send a receipt and approval via return email. Below are instructions regarding the completion of the calendar.

1. A calendar must be submitted for every nonpublic school program. List all facility codes that have been included on the application for approval.

2. Enter the name of the operating agency and nonpublic facility as it appears on the application. 3. Indicate all full days of student attendance (minimum of 5.0 clock hours) during the regular school

year with X; indicate all half days of student attendance during the regular school year with 1/2X. 4. Indicate all full student attendance days during the summer session with S; indicate all half days of

student attendance during the summer session with 1/2S. 5. Indicate all school holidays recognized by your facility with HOL. 6. Indicate all other days that students are NOT in attendance with NIA. Please note that weekend

days have already been deleted from the calendar. 7. Enter the beginning and closing dates of both the regular school year and summer session in the

spaces provided in the lower right-hand corner of the calendar. Each beginning and closing date must be a student attendance day.

8. The spreadsheet will total your days as entered for each month and will compute the totals for the

attendance days, holidays (HOL), and not in attendance (NIA) days at the bottom right-hand side of the form.

9. Enter the name of the person completing the form, the date, phone and fax numbers, and email

address. 10. Check the box for proposed calendar. Subsequent to the initial calendar submission, any calendar

amendments must be received no later than June 1, 2010, and should be identified by a check in the amended calendar box.

ATTACHMENT A




NONPUBLIC PROGRAM INSTRUCTIONAL PROGRAM SCHEDULE FOR 2010-2011 Program Code 037 Program Code 254 Facility Name Centerview Therapeutic-Day Regular School Year Begins (Enter Date*) Regular School Year Closes (Enter Date*) Student Attendance Days for Regular

School Year (176 Minimum) Number of Instructional Hours per Day

(Minimum of 5 hours per day) Summer School Session Begins (Enter Date*) Summer School Session Closes (Enter Date*) Student Attendance Days for Summer

Session Number of Instructional Hours per Day Total Hours Summer Session (Min 120 Hours) * All dates on this form must be student attendance days.




SUMMARY OF RELATED SERVICES FACILITY

INSTRUCTIONS: Complete the following data as of April 1 of the current year. No other form will be accepted.

1. Review the IEPs of all students currently enrolled under Section 14-7.02 of the School Code of Illinois. 2. Total the direct service minutes per week specified on the IEP for all students in each related service area. (do not include services to be provided directly by a public school district) 3. Divide by 60. If group services are indicated on IEPs, please note the amount of therapist time that will be needed. 4. Enter total number of IEP-specified direct service hours and minutes on this form. 5. Total the number of students requiring IEP-specified consultative services in each related service area. 6. Enter that number (from Step 5) on this form.

DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work

Counseling

Art Therapy

Music Therapy

Nursing


Other (Specify): The applicant will obey all laws, regulations, and executive orders prohibiting discrimination on the basis of race, color, national origin, sex, age, or handicap and all other laws, regulations, and executive orders applicable to its activities, including but not limited to the School Code (105 ILCS 5/1-1 et seq.), Title IX of the Amendments of 1972 (20 U.S.C. 1681 et seq.), the Illinois Human Rights Act (775 ILCS 5/1-101 et seq.), the Individuals with Disabilities Education Act (20 U.S.C. 1400 et seq.), the Age Discrimination in Employment Act of 1967 (29 U.S.C. 621 et seq.), Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq., 2000e et seq.), the Public Works Employment Discrimination Act (775 ILCS 10/0.01 et seq.), and the Americans with Disabilities Act of 1990 (42 U.S.C.A. 12101 et seq.). Pursuant to Public Act 84-411, Illinois Criminal Background Checks have been conducted on the employees of this facility. Additionally, the undersigned certifies, under penalty of perjury, that he/she is not more than thirty (30) days delinquent in complying with a child support order; that failure to so certify may result in a denial of the renewal, and that making a false statement may subject the undersigned to contempt of court under 305 ILCS 5/10 – 17 – 6 of the Illinois Public Aid Code. I, the undersigned, attest that the information provided on and included with this application is accurate and true, that this facility is in compliance with applicable Rules and Regulations for Approval of Nonpublic Special Education Facilities under Section 14-7.02 of the School Code of Illinois and agree that the Illinois State Board of Education has visitation rights to the above mentioned facility and may review the facility services to students for other statutory requirements under Section 14-7.02 of the School Code of Illinois. Date sent to Illinois State Board of Education Signature of Chief School Administrator Title



Special Education Services - Springfield Division DATE: March 2010 SUBJECT: 2010-2012 Renewal Applications for Residential Programs The procedure for renewal of applications to serve students (residential only) under Section 14-7.02 of the School Code of Illinois for the 2010-2012 school years is as follows: 1. Complete and sign (original signature required) the enclosed APPLICATION FOR ELIGIBILITY OF

NONPUBLIC PROGRAMS TO SERVE STUDENTS WITH DISABILITIES under Section 14-7.02 of the School Code.

2. If your fire inspection is over 24 months old, please attach a current copy of a fire inspection. Illinois

programs must submit an inspection from the Illinois State Fire Marshal; out-of-state programs must submit evidence of a fire inspection by a governmental entity in that area.

3. Residential licensing must be current. 4. In accordance with statutory requirements, you must submit your application for renewal by April 15,

2010. Mail to:


Special Education Services Division, N-253 100 North First Street

Springfield, Illinois 62777-0001 If you have questions, please contact Kathy Stratton at (217) 782-5589 ([email protected]), Paul Nijensohn at (312) 814-2205 ([email protected]) or Sarah Sebert at (312) 814-3999 ([email protected]).

- 1 -

Init ial Renewal







ADDRESS (Street, City, State, Zip Code) COUNTY 3667 Salem Walk, , Northbrook, IL, 60062 Cook






DCFS


10/30/2007


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -



_____________________________________________________



_____________________________________________________

Print Name


- 3 -

ATTACHMENT A














- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work

Counseling

Art Therapy

Music Therapy

Nursing


Other (Specify):

3/16/2010 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End






End 5 Days

Length Vacant

3/16/2010 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End


3/16/2010 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

3/16/2010 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End


3/16/2010 - 2 -



3/16/2010 - 3 -





Code of Illinois FROM: David Andel, Division Administrator Special Education Services DATE: March 2014 SUBJECT: 2014-2016 Renewal Applications for Education and Residential/Education

Combination programs Your program’s two-year approval will expire at the end of the current school year. The procedure for renewal of applications to serve students under Section 14-7.02 of the School Code of Illinois for the 2014-2016 school year(s) is as follows:


2. Carefully review all typed information on the first two pages of the application and submit any changes/updates, with any needed documentation.




changes/updates, including any necessary documentation.

6. Illinois Programs - If your Illinois State Fire Marshal inspection report is over 24 months

old and you have not had a more recent inspection, go to: http://webapps.sfm.illinois.gov/fprequest. Complete the form and submit it to the Office

NOTE: We have reviewed the information that is on file and have bolded areas where required information is missing, expired, or for which there are other questions/concerns. Your application will not be processed unless these areas are addressed. If you have questions, please call (312) 814-5560 or e-mail the consultant.

of the State Fire Marshal. Your application CANNOT be approved without a current, violation-free report from the State Fire Marshal.

7. Out-of-state programs - The fire inspection report from a governmental entity must also be within the last 24 months.


instructions.

9. If your program is approved to provide residential services, please make sure the license is current and provide a copy if the date shown on page one (1) of the application is expired.



Pam Solomon Illinois State Board of Education

Division of Special Education Services 100 West Randolph

Suite 4-800 Chicago, IL 60601

If you have questions, please contact Heather Zeman at (312) 814-8251 or by email at [email protected].







Heather Zeman at (312) 814 - 8251 or by email at [email protected]


___ Identifying information (address/phone/e-mail/administrator name, etc) at the top of the cover page has been changed, if necessary. ___The Illinois State Fire Marshal inspection or out-of-state fire inspection is not over 24 months old or a copy of a more recent one is included. ___If categories or ages of approval have been changed, a revised program description requesting the change is included. ___The application is signed (original signature required). ___Related service personnel are sufficient to meet the IEP needs listed on the Summary of Related Services page. Only related services to be provided by your program are listed. ___Related services are listed in individual hours and minutes or indicated as group hours and minutes. Consult services are only listed if indicated on the IEPs.

___IEIN #s are included for all new personnel with Illinois Professional Educator Licenses. Note: IEINs can no longer be found online through public access. Educators must login under “Educator Access” at www.isbe.net/elis to find their own IEIN. ___Current copies of educator licenses for personnel in out-of-state programs are included, unless our records show that the license on file is current. ___Current copies of professional licenses for personnel such as therapists and other licensed professionals in all programs are included, unless our records show that the license on file is current. ___Any changes of staff time indicate the dates the changes occurred. ___Dates are given for staff listed as terminated, newly hired, or moved to/from another program within the agency (the date of the move, not the date of the original start with the agency in another position or location). ___Updated policies/procedures, program description, and applicable residential licensure are included. ___For out of state programs, any renewed accreditation or licensure is included.

_______________________________ ________________________ Signature Phone number


Each nonpublic program seeking approval from the Illinois State Board of Education and a rate set by the Illinois Purchased Care Review Board must submit a school calendar detailing days in session for the program. The rate-setting process and publication of the nonpublic school approvals is dependent upon timely receipt of these calendars. The 2014-2015 calendar is available on our website and may be accessed by going to: http://www.isbe.net/spec-ed/html/nonpublic_se.htm You may save the file in Excel by pointing to “Calendar” under 2014-2015. Right-click, then choose ‘Save Target As’. Name your excel file, complete the calendar per the directions below, and email your saved document to Pam Solomon at [email protected] by April 15, 2014. Note: Ms. Solomon will send an approval and copy of approved calendar via email. Please do not send faxed copies. Below are instructions regarding the completion of the calendar.



application.


4. Indicate all full student attendance days during the summer session with S.


6. Indicate all other days that students are NOT in attendance with NIA. Please note that

weekend days have already been deleted from the calendar.

7. Enter the beginning and closing dates of both the regular school year and summer session in the spaces provided in the lower right-hand corner of the calendar. Each beginning and closing date must be a student attendance day.


for the attendance days, holidays (HOL), and not in attendance (NIA) days at the bottom right-hand side of the form. Check all totals to ensure accuracy.


email address.

10. Check the box for proposed calendar. Subsequent to the initial calendar submission, any calendar amendments must be received no later than June 1, 2014-2015, and should be identified by a check in the amended calendar box.

ATTACHMENT A














DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work

Counseling

Art Therapy

Music Therapy

Nursing




Code of Illinois FROM: David Andel, Division Administrator Special Education Services – Springfield Division DATE: March 2012 SUBJECT: 2012-2014 Renewal Applications for Education and Residential/Education

Combination programs Your program’s two-year approval will expire at the end of the current school year. The procedure for renewal of applications to serve students under Section 14-7.02 of the School Code of Illinois for the 2012-2014 school year(s) is as follows:


2. Carefully review all typed information on the first two pages of the application and submit any changes/updates, with any needed documentation.




changes/updates, including any necessary documentation.

NOTE: We have reviewed the information that is on file and have bolded areas where required information is missing, expired, or for which there are other questions/concerns. Your application will not be processed unless these areas are addressed. If you have questions, please call (312) 814-5560 or e-mail one of the consultants.

6. Illinois Programs - If your Illinois State Fire Marshal inspection report is over 24 months old and you have not had a more recent inspection, go to: http://www.isbe.net/spec-ed/word/fire_inspection_memo.doc. Complete the form and e-mail or fax it to us and we will forward it to the Office of the State Fire Marshal. Your application CANNOT be approved without a current report from the State Fire Marshal.

7. Out-of-state programs - The fire inspection report from a governmental entity must also be within the last 24 months.


instructions.

9. If your program is approved to provide residential services, please make sure the license is current.




Special Education Services Division N-253 100 North First Street

Springfield, IL 62777-0001

If you have questions, please contact Ms. Kathy Stratton at (217) 782-5589 ([email protected]) or Paul Nijensohn at (312) 814-2205 ([email protected]).







Paul Nijensohn (312) 814-2205, [email protected]


___ Identifying information (address/phone/e-mail/administrator name, etc) at the top of the cover page has been changed, if necessary. ___The Illinois State Fire Marshal inspection or out of state fire inspection is not over 24 months old or a copy of a more recent one is included or has been requested. ___If categories or ages of approval have been changed, a revised program description requesting the change is included, or there are no changes from the previous approval. ___Related service personnel are sufficient to meet the IEP needs listed on the Summary of Related Services page. Only related services to be provided by your program are listed. ___Related services are listed in individual hours and minutes or indicated as group hours and minutes. Consult services are only listed if indicated on the IEPs. ___The application is signed (original signature required). ___IEIN #s are included for all new personnel with Illinois education certificates or paraprofessional statements of approval. ___Current copies of educator licenses for personnel in out of state programs are included, unless our records show that the license on file is current. ___Current copies of professional licenses for personnel such as therapists and other licensed professionals in all programs are included, unless our records show that the license on file is current. ___Any changes of staff time indicate the dates the changes occurred. ___Dates are given for staff listed as terminated, newly hired, or moved to/from another program within the agency (the date of the move, not the date of the original start with the agency in another position or location).

ALL BOLDED AND HIGHLIGHTED AREAS HAVE BEEN ADDRESSED _______________________________ ________________________ Signature Phone number





application.











email address.


ATTACHMENT A














DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work

Counseling

Art Therapy

Music Therapy

Nursing





Special Education Services - Springfield Division DATE: March 2012 SUBJECT: 2012-2014 Renewal Applications for Residential Programs The procedure for renewal of applications to serve students (residential only) under Section 14-7.02 of the School Code of Illinois for the 2012-2014 school years is as follows: 1. Complete and sign (original signature required) the enclosed Application For Eligibility Of Nonpublic

Programs To Serve Students With Disabilities under Section 14-7.02 of the School Code. 2. If your fire inspection is over 24 months old, please attach a current copy of a fire inspection. Illinois

programs must submit an inspection from the Illinois State Fire Marshal; out-of-state programs must submit evidence of a fire inspection by a governmental entity in that area.

3. Residential licensing must be current. 4. Out of State Programs: Please note that the public school district your students attend MUST submit a

calendar. The calendar and instructions can be found at http://www.isbe.net/spec-ed/html/nonpublic_se.htm.

5. In accordance with statutory requirements, you must submit your application for renewal by April 15,

2012. Mail to:


Special Education Services Division, N-253 100 North First Street

Springfield, Illinois 62777-0001 If you have questions, please contact Kathy Stratton at (217) 782-5589 ([email protected]) or Paul Nijensohn at (312) 814-2205 ([email protected]).

- 1 -

Init ial Renewal













11/15/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -



_____________________________________________________



_____________________________________________________

Print Name

The following dates show when the program was updated: 7/12/2010 12/16/2010 2/3/2011 2/7/2011 3/22/2011 7/8/2011 3/12/2012 5/1/2012 8/22/2012 2/22/2013 3/7/2013 6/6/2013 7/10/2013 11/27/2013 3/12/2014

- 3 -

ATTACHMENT A












49



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work

Counseling

Art Therapy

Music Therapy

Nursing


Other (Specify):

3/12/2014 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant




3/12/2014 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End



09/03/13 Katherine Citti SC D/HH 10:2 X

3/12/2014 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

3/12/2014 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End






3/12/2014 - 2 -



Simon Bonita







Endrs: Secondary Education - Grade 6 through Grade 12






Lovell Rena








3/12/2014 - 3 -

Bridges Kelly



Citti Katherine



Zawacki Tamara




3/12/2014 - 4 -

3/12/2014 - 5 -






Michael Matzkin


Don Arocho

Kathryn Haver

3/12/2014 - 6 -

- 1 -

Init ial Renewal















11/15/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -



_____________________________________________________



_____________________________________________________

Print Name


- 3 -

ATTACHMENT A














- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work

Counseling

Art Therapy

Music Therapy

Nursing


Other (Specify):

3/12/2014 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End






End 5 Days

Length Vacant

3/12/2014 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End


3/12/2014 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

3/12/2014 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End


3/12/2014 - 2 -



3/12/2014 - 3 -




- 1 -

Init ial Renewal













02/11/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -



_____________________________________________________



_____________________________________________________

Print Name


- 3 -

ATTACHMENT A












49



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work

Counseling

Art Therapy

Music Therapy

Nursing


Other (Specify):

3/12/2012 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant





3/12/2012 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End






3/12/2012 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

3/12/2012 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End





3/12/2012 - 2 -



Heidi Herbon





Heather Hollowell








3/12/2012 - 3 -

Rena Lovell










Erin Moran



3/12/2012 - 4 -

Bonita Simon















Tracy Weyhrauch



3/12/2012 - 5 -

3/12/2012 - 6 -







Michael Matzkin

Kelly Bridges

Alyssa Giliberto


3/12/2012 - 7 -

- 1 -

Init ial Renewal













DCFS ?????????


03/18/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -



_____________________________________________________



_____________________________________________________

Print Name

The following dates show when the program was updated: 7/21/2010 8/10/2010 3/12/2012

- 3 -

ATTACHMENT A














- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work

Counseling

Art Therapy

Music Therapy

Nursing


Other (Specify):

3/12/2012 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End






End 5 Days

Length Vacant

3/12/2012 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End


3/12/2012 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

3/12/2012 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End


3/12/2012 - 2 -



3/12/2012 - 3 -




- 1 -

Init ial Renewal













02/11/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -



_____________________________________________________



_____________________________________________________

Print Name


- 3 -

ATTACHMENT A












49



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work

Counseling

Art Therapy

Music Therapy

Nursing


Other (Specify):

3/12/2012 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant





3/12/2012 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End






3/12/2012 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

3/12/2012 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End





3/12/2012 - 2 -



Heidi Herbon





Heather Hollowell








3/12/2012 - 3 -

Rena Lovell










Erin Moran



3/12/2012 - 4 -

Bonita Simon















Tracy Weyhrauch



3/12/2012 - 5 -

3/12/2012 - 6 -







Michael Matzkin

Kelly Bridges

Alyssa Giliberto


3/12/2012 - 7 -

- 1 -

Init ial Renewal













DCFS ?????????


03/18/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -



_____________________________________________________



_____________________________________________________

Print Name


- 3 -

ATTACHMENT A














- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work

Counseling

Art Therapy

Music Therapy

Nursing


Other (Specify):

3/12/2012 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End






End 5 Days

Length Vacant

3/12/2012 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End


3/12/2012 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

3/12/2012 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End


3/12/2012 - 2 -



3/12/2012 - 3 -





of Illinois for school years 2014-2016 FROM: David Andel, Division Administrator Special Education Services DATE: March 2015 SUBJECT: Reminder for submission of any changes Calendar submission for 2015-2016 Your program was approved last year for the 2014-2016 school year. Attached you will find instructions for completing the Nonpublic Program School Calendar for 2015-2016. Please submit the calendar to Pam Solomon via email at [email protected]. If you have any questions regarding the calendar, please contact Pam at (312) 814-5560 It is important that we continue to have accurate and current information about your program. At this time, please review the enclosed approved application and make any needed updates/corrections. If you have any questions regarding the application, please contact Viver Ballard at (312) 814-8246 or by email at [email protected]. Mail, email, or fax change notifications to:

Viver Ballard Illinois State Board of Education



(312) 814-3171 (fax) [email protected]


Each nonpublic program seeking approval from the Illinois State Board of Education, Special Education Services Division, and a rate set by the Illinois Purchased Care Review Board must submit a school calendar detailing days in session for the program. The rate-setting process and publication of the nonpublic school approvals is dependent upon timely receipt of these calendars. The 2015-2016 calendar is available on our website and may be accessed by going to: http://www.isbe.net/spec-ed/html/nonpublic_se.htm You may save the file in Excel by pointing to “Calendar” under 2015-2016. Right-click, then choose ‘Save Target As’. Name your excel file, complete the calendar per the directions below, and email your saved document to Pam Solomon at [email protected] by April 15, 2015. Note: Ms. Solomon will only accept the proposed calendar via email. Please do not send faxed copies. Below are instructions regarding the completion of the calendar.



application.










email address.

10. Check the box for proposed calendar. Ms. Solomon will send an approval and a copy of the approved calendar via email only.

11. Subsequent to the initial calendar submission, any calendar amendments must be

received no later than June 1, 2015-2016, and should be identified by a check in the amended calendar box.


of Illinois for school years 2014-2016 FROM: David Andel, Division Administrator Special Education Services DATE: March 2015 SUBJECT: Reminder for submission of any changes Calendar submission for 2015-2016 Your program was approved last year for the 2014-2016 school year. Attached you will find instructions for completing the Nonpublic Program School Calendar for 2015-2016. Please submit the calendar to Pam Solomon via email at [email protected]. If you have any questions regarding the calendar, please contact Pam at (312) 814-5560 It is important that we continue to have accurate and current information about your program. At this time, please review the enclosed approved application and make any needed updates/corrections. If you have any questions regarding the application, please contact Viver Ballard at (312) 814-8246 or by email at [email protected]. Mail, email, or fax change notifications to:

Viver Ballard Illinois State Board of Education



(312) 814-3171 (fax) [email protected]


Each nonpublic program seeking approval from the Illinois State Board of Education, Special Education Services Division, and a rate set by the Illinois Purchased Care Review Board must submit a school calendar detailing days in session for the program. The rate-setting process and publication of the nonpublic school approvals is dependent upon timely receipt of these calendars. The 2015-2016 calendar is available on our website and may be accessed by going to: http://www.isbe.net/spec-ed/html/nonpublic_se.htm You may save the file in Excel by pointing to “Calendar” under 2015-2016. Right-click, then choose ‘Save Target As’. Name your excel file, complete the calendar per the directions below, and email your saved document to Pam Solomon at [email protected] by April 15, 2015. Note: Ms. Solomon will only accept the proposed calendar via email. Please do not send faxed copies. Below are instructions regarding the completion of the calendar.



application.










email address.

10. Check the box for proposed calendar. Ms. Solomon will send an approval and a copy of the approved calendar via email only.

11. Subsequent to the initial calendar submission, any calendar amendments must be

received no later than June 1, 2015-2016, and should be identified by a check in the amended calendar box.

- 1 -

Init ial Renewal













11/15/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -






_____________________________________________________

Print Name

The following dates show when the program was updated: 7/12/2010 12/16/2010 2/3/2011 2/7/2011 3/22/2011 7/8/2011 3/12/2012 5/1/2012 8/22/2012 2/22/2013 3/7/2013

- 3 -

ATTACHMENT A












48



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work


Group - 25

30

20

0

0

Art Therapy

Music Therapy



Other (Specify):

Psychiatric

1 19

3/7/2013 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant





3/7/2013 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End






3/7/2013 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

3/7/2013 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End






3/7/2013 - 2 -



Kelly Bridges



Heidi Herbon





Aprv:Learning Behavior Specialist I

Heather Hollowell








3/7/2013 - 3 -

Rena Lovell










Erin Moran



Abygail Peters






3/7/2013 - 4 -

Bonita Simon















Tracy Weyhrauch



3/7/2013 - 5 -

3/7/2013 - 6 -







Michael Matzkin


Ricardo Ruiz

3/7/2013 - 7 -

- 1 -

Init ial Renewal















11/15/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -






_____________________________________________________

Print Name


- 3 -

ATTACHMENT A














- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work

Counseling

Art Therapy

Music Therapy

Nursing


Other (Specify):

3/7/2013 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End






End 5 Days

Length Vacant

3/7/2013 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End


3/7/2013 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

3/7/2013 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End


3/7/2013 - 2 -



3/7/2013 - 3 -




- 1 -

Init ial Renewal













02/11/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -



_Sarah Sebert



_____________________________________________________

Print Name


- 3 -

ATTACHMENT A












49



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work


Group - 20

30

15

Art Therapy

Music Therapy



Other (Specify):


1 15

2/3/2011 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant





2/3/2011 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End





2/3/2011 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

2/3/2011 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End





01/10/11 Erin Moran 1:1 Aide X

2/3/2011 - 2 -



Heather Hollowell





Heidi Hondorp




Rena Lovell










2/3/2011 - 3 -

Bonita Simon

















Michael Matzkin


Sam Kapacinskas

Nikki Bonarirgo

- 1 -

Init ial Renewal













02/11/2010


ACCEPTED AGE RANGE

14-7.02



14-7.02

ENROLLMENT








- 2 -



_Sarah Sebert



_____________________________________________________

Print Name


- 3 -

ATTACHMENT A












49



- 4 -








DIRECT


Hours Minutes


Physical Therapy


Speech

Social Work


Group - 20

30

15

Art Therapy

Music Therapy



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1 15

2/3/2011 - 1 -




PERSONNEL RECORD






Hrs/Wk Start

5 Days End








End 5 Days

Length Vacant





2/3/2011 - 2 -

ATTACHMENT D



PERSONNEL RECORD






5 Days End





2/3/2011 - 1 -

ATTACHMENT E

PERSONNEL RECORD




TION DATE

TEACHER’S NAME


Start 5 Days

End 5 Days

Length Vacant

2/3/2011 - 1 -

ATTACHMENT F

PERSONNEL RECORD





5 Days End





01/10/11 Erin Moran 1:1 Aide X

2/3/2011 - 2 -



Heather Hollowell





Heidi Hondorp




Rena Lovell










2/3/2011 - 3 -

Bonita Simon

















Michael Matzkin


Sam Kapacinskas

Nikki Bonarirgo

2/3/2011 Bonita Simon Centerview Therapeutic-Day 3444 Dundee Rd Northbrook, IL 60062 Dear Bonnie: Thank you for the updated information which was received by our office by fax on January 26, 2011. The following update(s) you provided have been reviewed and accepted. Personnel

Use copies of these forms when reporting future changes. You need only send copies of the pages with changes. Please remember to include copies of new licenses as well as the IEIN numbers for new staff members who have Illinois State Board of Education certification or approval. Note that Rena L always shows in bold. That is because she has an expired Elementary certificate that the computer won’t let go of. Usually bold means something is wrong, but it is OK, just that I can’t change it. fyi


Sarah Sebert

Principal Consultant Special Education Services Illinois State Board of Education

cc: Kathy Stratton, Illinois State Board of Education

2/3/2011 Bonita Simon Centerview Therapeutic-Day 3444 Dundee Rd Northbrook, IL 60062 Dear Bonnie: Thank you for the updated information which was received by our office by fax on January 26, 2011. The following update(s) you provided have been reviewed and accepted. Personnel

Use copies of these forms when reporting future changes. You need only send copies of the pages with changes. Please remember to include copies of new licenses as well as the IEIN numbers for new staff members who have Illinois State Board of Education certification or approval. Note that Rena L always shows in bold. That is because she has an expired Elementary certificate that the computer won’t let go of. Usually bold means something is wrong, but it is OK, just that I can’t change it. fyi


Sarah Sebert

Principal Consultant Special Education Services Illinois State Board of Education

cc: Kathy Stratton, Illinois State Board of Education

application for eligibility of nonpublic ... - … state board of education ... impairment...

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