Technical Assistance Request
LINK Peer to Peer Support Program – 2014-15
Contact Person:
Date:
District:
Building:
Email:
Phone:
Please complete this form and action plan below and submit to: Melissa Kurek at kurekm@gvsu.edu
List BUILDINGS in District / RCN
Total # of Students in
each Building
# of Students with ASD in
each Building
Early Childhood Programs -
Elementary Buildings -
Middle School Buildings -
High School Buildings -
Post High School -
Other –
Total Student Population for the
District/RCN
Total number of students
with ASD in District/RCN
START Project January 2015
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1. Do you have a building team to help you set up the LINK program?
Yes
No
If yes, please list team members: (Possible team members listed)
Possible Team member /
Role
Have attended
START P2P
Module
Name
Will be attending
START P2P
Module
Assistant Principal
Counselor
Special Education Teacher
General Education Teacher
Social Worker
Principal
To see when the next Peer to Peer Support Training is scheduled, please visit the START
website and go to START EVENTS - http://www.gvsu.edu/autismcenter/start-events-49.htm
2. Have you utilized resources within your district/RCN to implement P2P?
Yes
No
3. Have you informed, and obtained the support of your Special Education Director?
Yes
No
Sp. Ed. Director’s Name:
P #:
4. Has the Special Education Director Attended the START ½ Day Administration Module?
Yes
No
To see when the next Administration Module is scheduled, please visit the START website and
go to START EVENTS - http://www.gvsu.edu/autismcenter/start-events-49.htm
5. Have you informed, and obtained the support of the Building Principal?
Yes
No
Principal’s Name:
P #:
6. Has the Building Principal attended the START ½ Day Administration Module?
Yes
No
To see when the next Administration Module is scheduled, please visit the START website and
go to START EVENTS - http://www.gvsu.edu/autismcenter/start-events-49.htm
7. Do you currently have a formal or informal Peer to Peer Support Program developed and
implemented in your building or district? Or a program similar (check other)?
Formal Peer to Peer Support Program (as defined by approval through your
curriculum council (K-12) and adopted by your board of education as a course)
Informal Peer to Peer Support Program
Other:
(e.g. peer mentoring, PALS)
START Project January 2015
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8. Have you and your team reviewed the document “Peer to Peer Support as an Elective Class
Credit Proposal” on the START Website?
Yes
No
9. START would expect the Peer to Peer Support Program to be formalized which means your
team would need to present the “Peer to Peer Support as an Elective Class Credit Proposal to
the district K-12 Curriculum Committee. There are several steps needed to complete the
proposal:

Reviewing the MDE Pupil Accounting manual Section 6-B – LINKS Program

Which Model is your building planning on implementing?
Model 1: General Education Elective
Special Education Teacher - General Education Certified in the Grade Level of the Elective
Model 2: General Education Elective
Peer to Peer Support Teacher – Certified in the Grade Level of the Elective
Model 3: General Education Elective
General Ed Teacher – Also Teaching General Ed Content Course
Model 4: General Education Elective
Special Ed Teacher – Also Teaching Special Education Program

Does your team need help with?
Adding the Peer to Peer Class to your school’s catalog?
Yes
No
Reviewing the START curriculum for a LINK class?
Yes
No
10. Have you provided some level of sensitivity awareness training to the building and if so at
what level (e.g. staff training, building team, students).
Sensitivity Awareness Training
Level was provided to:
Yes
No
11. In which semester / school year would you like to start a LINK program?
Semester:
First
Second
School year:
2014-15
2015-16
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Typed Signature:
Date:
START Project January 2015
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ACTION PLAN
Team:
Date:
WHO
will do WHAT
by WHEN
START Project January 2015
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