ITS 2026-004 INDIVIDUALIZED EDUCATIONAL SERVICES

Agency: Anchorage School District
State: Alaska
Type of Government: State & Local
NAICS Category:
  • 611710 - Educational Support Services
Posted Date: May 22, 2026
Due Date: May 27, 2026
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ITS 2026-004 INDIVIDUALIZED EDUCATIONAL SERVICES
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Invitation to Submit
ITS 2026-004 INDIVIDUALIZED EDUCATIONAL SERVICES -- 334 KB

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_________________________________________________________________________ Purchasing Department, 4919 Van Buren Street, Anchorage, AK 99517-3137
INVITATION TO SUBMIT THIS IS NOT AN ORDER
Show the following on the outside of all envelopes submitted OR email subject line: ITS 2026-004 Individualized Educational Services DATE ISSUED: May 21, 2026 DUE: Prior to 2:00 p.m., Local Time DATE: May 27, 2027
Section Title Pages
Cover Page Invitation to Submit Consisting of 1 page
Section I Instructions to Offerors Consisting of 7 pages
Attachment A Signature Page/Submittal Form Consisting of 1 page
Attachment B Description of Services and Fee Schedule Consisting of 1 page
Attachment C Insurance Coverage Consisting of 2 pages
Exhibit No. 1 Submittal Checklist - Current Approved Contractors Consisting of 1 page
Exhibit No. 2 Submittal Checklist - New Contractors - Initial Requirements Consisting of 2 pages
Exhibit No. 3 Interested Person's Report and Background Check/Fingerprinting Information Consisting of 1 page
Exhibit No. 4 Fingerprinting Authorization Form Consisting of 1 page

_________________________________________________________________________
Purchasing Department, 4919 Van Buren Street, Anchorage, AK 99517-3137
INVITATION TO SUBMIT
THIS IS NOT AN ORDER
Show the following on the outside of all
envelopes submitted OR email subject line:
ITS 2026-004 Individualized Educational DATE ISSUED: DUE: Prior to 2:00 p.m., Local Time
Services May 21, 2026 DATE: May 27, 2027
The Anchorage School District (referred to as the "District") invites SUBMITTALS from qualified persons/firms to
provide INDIVIDUALIZED EDUCATIONAL SERVICES to the District in accordance with the following
documents that are a part of this ITS:
Section Title Pages
Cover Page Invitation to Submit Consisting of 1 page
Section I Instructions to Offerors Consisting of 7 pages
Attachment A Signature Page/Submittal Form Consisting of 1 page
Attachment B Description of Services and Fee Schedule Consisting of 1 page
Attachment C Insurance Coverage Consisting of 2 pages
Exhibit No. 1 Submittal Checklist - Current Approved Contractors Consisting of 1 page
Exhibit No. 2 Submittal Checklist - New Contractors - Initial Requirements Consisting of 2 pages
Exhibit No. 3 Interested Person's Report and Background Check/Fingerprinting Consisting of 1 page
Information
Exhibit No. 4 Fingerprinting Authorization Form Consisting of 1 page
AVAILABILITY OF ITS: This Invitation to Submit (.pdf) is available electronically at the District's Purchasing Department
website: https://www.asdk12.org/Page/5417.
ITS SUBMISSION METHOD: Please submit all required documents to the Anchorage School District Purchasing
Department, 4919 Van Buren Street, Anchorage, AK 99517-3137 prior to the date and time specified in the header of this
cover page. Submissions can be mailed, hand delivered, or emailed. Submissions shall be clearly labeled on the outside of
envelopes with the offeror's name, address, and phone number, and as follows:
INVITATION TO SUBMIT
ITS 2026-004 Individualized Educational Services
Email submissions can be sent to purchasing@asdk12.org - Attn: Thomas Johns, Operations Supervisor,
Purchasing/Warehouse. Reference: ITS 2026-004 Individualized Educational Services
AWARD: Award of any contract as a result of this Invitation to Submit will be at the sole discretion of the District and is
contingent upon the availability of funds. The District reserves the right to reject any and all submissions and to act in the
best interest of the District.

ANCHORAGE SCHOOL DISTRICT
ITS 2026-004 Individualized Educational Services
SECTION I
INSTRUCTIONS TO OFFERORS
A. GENERAL REQUIREMENTS
This solicitation is an INVITATION TO SUBMIT (referred to as "ITS") governed by applicable Anchorage
School Board Policies, Administrative Regulation 3311.1(b) of said Policies. School Board Policies are available
at https://www.boardpolicyonline.com/?b=anchorage. Offerors should read this ITS carefully and review all
instructions contained herein. Incomplete or incorrect offers may be rejected as not conforming to the essential
requirements of this ITS.
B. EXAMINATION OF DOCUMENTS
Offerors should read this ITS and review all instructions contained herein. A submission shall constitute
acknowledgement that the offeror has thoroughly examined and is familiar with the solicitation documents.
C. INTENT OF THE SOLICITATION
1. The intent of this ITS is to establish multiple Education Service Agreements with contractors to
provide Individualized Educational Services for ASD students. This ITS is to allow for multiple
contractors, who agree to the District's Contract Terms and Conditions, to provide Individualized
Educational Services to District students. Individualized Educational Services provided will be
academic instruction directly related to the student's I.E.P. and include, but are not limited to;
mathematics, English/language arts skills, written expression, use of assistive technology or
speech generating devices, fine or gross motor skill development, study skill acquisition related to
executive function development, behavioral therapy and interventions, social skills instruction and
application, adaptive skill development, including but not limited to independent living skills,
access to community and transition or vocational skills. Instruction may be provided in group or
individual settings. Instruction may be in person or through remote access. Services must be for
educational instruction with students.
2. Clothing, equipment, food, and lodging are not covered or allowable expenses. Services provided are
subject to District regulations. (for example; District funds shall not be used to pay for instruction by a
family member).
3. Contractors will be governed by the District's and the Alaska Department of Education & Early
Development's guidelines for non-sectarian curricula.
4. District families of students who require Individualized Educational Services as designated on a student's
I.E.P. by the Anchorage School District will work with the appropriate ASD representative to choose an
approved vendor from the Individualized Educational Services list. Contractors have the responsibility to
make certain that all contractual documents are in place and that funding has been allocated (inclusive of
party responsible for payment) prior to providing services. Contractors will be paid commensurate to
services provided to students.
5. The list of approved contractors maintained by the District will be available and can be utilized by all
schools and departments throughout the District. Again, contractors have the responsibility to make
certain that all contractual documents are in place and that funding has been allocated (inclusive
of party responsible for payment whether that be the parent, school, or department) prior to
providing services.
SECTION I INSTRUCTIONS TO OFFERORS Page 1 of 7

ANCHORAGE SCHOOL DISTRICT
ITS 2026-004 Individualized Educational Services
D. DEBARMENT AND SUSPENSION
Offerors must fully comply with the requirements regarding debarment and suspension in Subpart C of 2 CFR
Part 180, as adopted by the Department of Education at 2 CFR 3485.12. Offerors are responsible for ensuring
lower tier covered transactions include a term or condition requiring compliance with Subpart C of 2 CFR Part
180 and 2 CFR Part 3485, entitled Responsibilities of Participants Regarding Transactions. Contractors,
subcontractors, or suppliers that appear on the Excluded Parties List System are not eligible for award of
contracts that are a covered transaction under Subpart B of 2 CFR Part 180 and 2 CFR Part 3485. Offerors
may access the Excluded Parties List System at https://www.sam.gov/SAM/.
E. CONFLICT OF INTEREST
1. The Contractor agrees to certify that District employees, School Board members, or a member of their
household are not in conflict of interest with the contract and Board Policy 3311, Administrative Regulation
3311.1(e).1.
2. Board Members, District employees, and their household and/or immediate family members are required to
comply with Board Policy 3311, Administrative Regulation 3311.1(e).1 and the Municipal Ethics Code by
disclosing conflicts of interest. The responsibility for complete and timely filing rests solely with the Board
Member or District employee.
Note: Notice of Intent to Respond to Public Solicitation shall be filed with the Municipal Clerk's office in advance
to allow a minimum of seven (7) calendar days to elapse between electronic publication by the clerk and the
final date for submitting a response to the solicitation. The form may be obtained from the Municipality of
Anchorage website, www.muni.org/.
District Disclosure and Request for Waiver forms and instructions may be obtained from the District's Purchasing
Department webpages, https://www.asdk12.org/Page/8014
3. Copies of all conflict of interest and ethics code documents should be submitted with your offer.
F. ALASKA BUSINESS LICENSE
If applicable, the selected offeror must provide the District with the offeror's Alaska business license number
prior to award. Offerors should contact the State of Alaska; Department of Commerce, Community and
Economic Development; Division of Corporations, Business & Professional Licensing, for information
regarding business licensing. Contact information, information regarding business licensing, and business
licenses, is available at www.commerce.alaska.gov/web/cbpl/BusinessLicensing.aspx.
G. THE DISTRICT
1. Two (2) of the District's core values are that "Every student deserves the opportunity to achieve his or her potential"
and that "Public education should be responsive to an ever-changing world." In support of these core values, the
District offers neighborhood schools, alternative schools, correspondence schools, charter schools, and
individual programs as a viable non-sectarian, educational option. If Individualized Educational Services
must be provided outside of the course of a student's normal instructional day. Such services are available
to any eligible student regardless of their school or program enrollment.
2. Educational opportunities in the District are outlined/summarized on the District's website at
www.asdk12.org/aboutschools/. Extensive information regarding enrollment, ranking, diversity,
programs, etc., is also available on the District's website at www.asdk12.org/aboutasd/.
SECTION I INSTRUCTIONS TO OFFERORS Page 2 of 7

ANCHORAGE SCHOOL DISTRICT
ITS 2026-004 Individualized Educational Services
H. FEDERAL EXCISE TAXES
The District is exempt from Federal Excise Taxes. An Exemption Certificate will be furnished when required.
I. QUESTIONS; METHOD FOR CLARIFICATION
1. Any offeror in doubt as to the true meaning of any part of this ITS may submit to the District a written
request for an interpretation thereof. Questions can be submitted as follows:
Reference: ITS 2026-004 Individualized Educational Services
Email: purchasing@asdk12.org
[OR fax: Anchorage School District Purchasing Department, 907-243-6293]
Attn: Thomas Johns, Operations Supervisor, Purchasing/Warehouse
2. Two types of questions generally arise. One may be answered by directing the offeror to a specific section
of the ITS. These questions may be answered by direct communication to the offeror submitting the
question. Questions which, in the opinion of the Purchasing Senior Director, require a more detailed or
complex reply, or require an answer that may affect responses to this ITS or may be prejudicial to other
prospective offerors, will be answered by issuing an addendum prior to the submission due date.
3. The District's Purchasing Department will be closed beginning December 23rd and will reopen the first
business day after January 2nd . Any emails, correspondence, questions, and others received during the
closure will be responded to, if required, as soon as possible after the Department reopens.
J. SUBMISSION OF OFFER
1. The Signature Page/Submittal Form (Attachment A) must be completed and manually signed by an
authorized representative of the firm submitting the offer and returned with all other required documents.
2. CURRENT APPROVED CONTRACTORS - see Exhibit No. 1 - Submittal Checklist - Current
Approved Contractors - Section B. Required Documents for Submission.
OR
NEW CONTRACTORS - see Exhibit No. 2 - Submittal Checklist - New Contractors - Initial
Requirements - Section B. Required Documents for Submission.
3. Any documentation not submitted in the manner required by the District, incomplete submissions, and
submissions lacking required signatures, will not be returned; however, the District may request additional
information and/or materials.
4. Offerors should be aware that addenda may be issued for this ITS. It is the offeror's responsibility to
ascertain if addenda have been issued by checking the District's Purchasing Department website:
www.asdk12.org/purchasing/.
5. It is the responsibility of the offeror to ensure that their submittal and all required documents are received
by the Purchasing Department prior to the due date and time.
SECTION I INSTRUCTIONS TO OFFERORS Page 3 of 7

ANCHORAGE SCHOOL DISTRICT
ITS 2026-004 Individualized Educational Services
K. DESCRIPTION OF SERVICES AND FEE SCHEDULE
All submissions/offers shall specify the Description of Individualized Educational Services and pricing for each
applicable service offered on Attachment B - Description of Services and Fee Schedule. All prices shall be net,
FOB Destination, and be stated in U.S. dollars.
L. PROCUREMENT CARD PAYMENT
The District desires to utilize Procurement Cards (credit cards) as a method of payment under any contract
awarded as a result of this ITS for all individual purchases under $2,500. The Contractor's authorization of
Procurement Card payments can be so indicated on Attachment B - Description of Services and Fee Schedule
Form of this ITS.
M. INSURANCE COVERAGE
The Contractor shall submit proof of all required/appropriate insurance as identified on Attachment C -
Insurance Coverage and maintain such throughout the term of the contract and in order to maintain approved
contractor status.
N. INTERESTED PERSON'S REPORT AND BACKGROUND CHECK/FINGERPRINTING
1. Sole Proprietors must provide proof of criminal records search (Interested Person's Report) by the Alaska
State Troopers office at 5700 East Tudor Road, Anchorage, Alaska (See Exhibit No. 3), and proof of
background check/fingerprinting by a District approved contractor (See Exhibit No. 3). Copies of receipts
are required to be submitted with this agreement. Final reports are required to be submitted by a District
approved background check/fingerprinting vendor (See Exhibit No. 3 - Section B) to the District Human
Resources Department at the following address:
Anchorage School District
Human Resources Department
5530 E. Northern Lights Blvd.
Anchorage, AK 99504-3135
NOTE: Contractor/Individual has a duty to immediately report to the District Principal or Department
Supervisor any arrest, charge, or conviction for felony or misdemeanor crimes. Traffic violations do not
require reporting unless job related.
2. Businesses/Companies/Corporations with a storefront and/or employee, and owners of Limited
Liability Companies must have background check policies and procedures in place and are liable for
their employees, sub-contractors and/or volunteers. Background check policies and procedures may
be requested by the District for review. Include with your submission an attachment listing all employees,
sub-contractors and/or volunteers who will be providing services under this agreement/contract. This List
of Employees, sub-contractors and/or volunteers Attachment must be amended during the course of the
contract if any additional employees will be providing services. The contractor certifies that, to their
knowledge, no employee or agent is a convicted sex offender or child kidnapper.
NOTE: Contractor/Individual has a duty to immediately report to the District Principal or Department
Supervisor any arrest, charge, or conviction for felony or misdemeanor crimes. Traffic violations do not
require reporting unless job related.
SECTION I INSTRUCTIONS TO OFFERORS Page 4 of 7

ANCHORAGE SCHOOL DISTRICT
ITS 2026-004 Individualized Educational Services
3. Applicant Notification and Record Challenge: If fingerprints are required, Contractor/Individual
fingerprints will be used to check the criminal history records of the FBI. Contractor/Individual has the
opportunity to complete or challenge the accuracy of the information contained in the FBI identification
record. The procedure for obtaining a change, correction, or updating a FBI identification records are set
forth in Title 28, CFR, 16.34, https://www.gpo.gov/fdsys/granule/CFR-2010-title28-vol1/CFR-2010-
title28-vol1-sec16-34
O. RIGHT OF REJECTION, CLARIFICATION, AND CANCELLATION
The District reserves the right to reject any and all offers, to request clarification of information from any
offeror and to waive irregularities in the submission procedures. The District is not obligated to enter into a
contract on the basis of any offer submitted in response to this ITS. The District reserves the right, at its sole
discretion, to cancel this ITS or any part thereof, at any time, prior to the award of contract under this ITS.
P. REQUEST FOR ADDITIONAL INFORMATION
Prior to the final approval, offerors may be required to submit additional information, which the District may
deem necessary to further evaluate the offeror's submission. Responses are due within three (3) calendar days
of request by the District.
Q. DISTRICT NOT RESPONSIBLE FOR PREPARATION COSTS
The District will not pay any cost associated with the preparation, submittal, presentation, or evaluation of any
offer. The District shall not be liable for any cost incurred by an offeror in responding to this solicitation or
incurred for any work done, even in good faith, prior to execution of a contract and issuance of a notice to
proceed, including but not limited to: offer preparation costs and other costs, including attorney fees associated
with any challenge (administrative, judicial or otherwise) to the determination of the lowest responsive,
responsible offeror and/or award of contract and/or rejection of offers. By submitting an offer, each offeror
agrees to be bound in this respect and waives all claims to such costs and fees.
R. CONTRACTOR APPROVAL TERM AND EDUCATIONAL SERVICE AGREEMENT TERM
1. Contractor Approval Term: The term of any contractor approval, resulting from this solicitation, shall be
for 24 months from the date of approval. A list of approved contractors will be maintained by the District.
To maintain contractor approval status, the contractor will be required to respond, prior to their 24 month
expiration date, to the annually issued ITS for Individualized Educational Services posted on the District's
website at that time.
2. Educational Services Agreement (ESA) Term: The term of any ESA between the District and any approved
contractor who is offered and accepts an ESA resulting from solicitation, shall be from the date of the
contract through the end of the current fiscal year, June 30. The District reserves the sole right thereafter
to offer additional extensions of the contract term, upon terms and conditions mutually agreeable to the
parties, pursuant to the continued availability of funding, satisfactory contractor performance, and the
continued need for the products or services provided under the contract, if found to be in the District's
best interest. Contractors have the responsibility to make certain that all contractual documents are in place
and that finding has been allocated (inclusive of party responsible for payment) prior to providing services.
S. UTILIZATION GUARANTEE
Interested parties are hereby notified that the District makes no expressed guarantee of an award or a minimum
estimated value of an award of an ESA, as a result of this ITS. Upon becoming approved as an educational
vendor, the District's programs/schools are not obligated to utilize any of the services offered by any approved
SECTION I INSTRUCTIONS TO OFFERORS Page 5 of 7

ANCHORAGE SCHOOL DISTRICT
ITS 2026-004 Individualized Educational Services
educational vendor. The District programs/schools reserve the right to select any approved educational vendor
for services, based on their own specific program needs/vendor qualifications, as needed. Therefore, there is
no implied or expressed guarantee that an approved educational vendor will be utilized as a result of becoming
an approval educational vendor when responding to this ITS.
T. CONTRACT
Any contract(s), as a result of this solicitation, between the District and the offeror shall consist of (1) the
Purchase Order, (2) the ITS and any addenda thereto, (3) any and all documents submitted by the offeror in
response to the ITS inclusive of any additional submission documents requested by the District, and (4) the
consummated Educational Services Agreement. In the event of a conflict in language between the documents
referenced above, the provisions and requirements set forth and/or referenced in the ITS shall govern;
however, the District reserves the right to clarify any contractual relationship in writing with the concurrence
of the contractor, and such written clarification shall govern in case of conflict with the applicable requirements
stated in the ITS or the contractor's submission. In all other matters not affected by the written clarification, if
any, the ITS shall govern.
In addition to reading all of the information in the ITS, offerors must read and review the standard
agreement terms and conditions;
https://drive.google.com/file/d/15A9FHT2cV26D9NnFYVULOiikWvTBKfVV/view?usp=sharing
The successful contractor(s) shall be required to enter into an Educational Service Agreement with
each school or department for which they are providing services. The Educational Service Agreement
will be substantially similar to the sample.
U. USE OF DISTRICT/DISTRICT PROGRAM/SCHOOL SEAL OR LOGO
Vendors shall not use any District, District program, or school seal(s), logos, crests, or reproductions or likeness
of District employees or officials without the express pre-approval by the District's Sr. Purchasing Director or
designee. Vendors shall not refer to themselves as District, District program, or School teachers, the vendor
designation to be used is Educational Vendor or Vendor only.
V. CONTRACT FUNDING; NON-APPROPRIATION
The contract is contingent upon funding. No financial obligation beyond a current District fiscal/school year
shall exist under the contract unless and until an appropriation of funds to be expended on the contract for the
following fiscal/school year is made by the Anchorage School Board. In the event that the School Board does
not appropriate or allocate funds or appropriates or allocates insufficient funds for the following fiscal/school
year, the District shall notify the contractor and the contract shall terminate on the last day of the preceding
fiscal/school year, or on the date when appropriated or allocated funds for the contract are exhausted. Under
no event shall the District be financially obligated to the contractor in any way beyond amounts appropriated
and allocated by the School Board for the contract. If funding for any fiscal/school year is reduced or
terminated by the School Board for purposes of this contract, the District shall have the option to either cancel
the contract with no liability occurring to the District or offer to amend the contract with the contractor that
reflects the reduced amount and reduced scope of work.
W. TECHNICAL OR CONTRACT RESOLUTION MEETINGS
The contractor will be required to meet with the District's project manager, or their designated representative(s),
to resolve technical and/or contractual issues that may occur during the term of the contract, at no additional
cost to the District. Meetings will occur as issues arise and will be coordinated by the District. Failure to
participate in resolution meetings or failure to make a good faith effort to resolve issues may result in
termination of the contract.
SECTION I INSTRUCTIONS TO OFFERORS Page 6 of 7

ANCHORAGE SCHOOL DISTRICT
ITS 2026-004 Individualized Educational Services
X. PUBLIC RECORDS CLAUSE
This ITS and the resulting offers received, together with copies of all documents pertaining to the award of a
contract, will be kept by the District's Purchasing Department and made part of the record which will be open
to public inspection after award of contract. If an offer contains any information which is proprietary or
confidential, each page of the offer containing such information must be clearly marked. Cost or price
information will be open to public inspection after award of contract.
END OF SECTION I
SECTION I INSTRUCTIONS TO OFFERORS Page 7 of 7

ANCHORAGE SCHOOL DISTRICT
ITS 2026-004 Individualized Educational Services
ATTACHMENT A
SIGNATURE PAGE/SUBMITTAL FORM
This form must be completed, signed, and returned with the offeror's submission.
Addendum Number(s) _________ is/are hereby acknowledged.
FOR OFFERORS USE ONLY
PLEASE COMPLETE ALL APPROPRIATE INFORMATION
DATE:
OFFEROR/FIRM:
MAILING ADDRESS:
CITY/STATE/ZIP:
PHYSICAL BUSINESS ADDRESS:
CITY/STATE/ZIP:
CONTACT PERSON FOR THIS SOLICITATION:
TELEPHONE NO: FAX NO:
EMAIL ADDRESS:
FEDERAL TAX ID NO: ALASKA BUSINESS LICENSE NO:
CERTIFICATION
I certify that I am a duly authorized representative of the firm listed above and that the information and materials
submitted accurately represent the capabilities of the firm to provide the services indicated in compliance with all
requirements of the solicitation. I certify that no member of the School Board or District employee, or spouse, or other
member of their household, has or shall have any undisclosed interest in the firm or this offer, as provided in the
Instructions to Offerors - Conflict of Interest. The District is hereby authorized to request from any individual any
pertinent information deemed necessary to verify information regarding the capacity of the firm or for purposes of
determining responsiveness of the submission or responsibility of the firm as a prospective contractor.
In compliance with the solicitation, if this offer is accepted, the offeror agrees to furnish the required services at the
times and locations specified in the executed Educational Service Agreement.
OFFEROR SIGNATURE:
PRINTED NAME:
PRINTED TITLE:
ATTACHMENT A SIGNATURE PAGE/SUBMITTAL FORM Page 1 of 1

Description of Individualized Educational Service Rate (As specified in attached rate sheet) Unit of Measure (As specified in attached rate sheet)
Tutor, without teaching credential $24.58 Hour
Tutor, with teaching credential $45-60 Hour
SLP, providing therapy or social skills instruction $42.93 - $60 Hour
OT, proving therapy $46.33 Hour
BVI instruction, Orientation and Mobility (low vision therapists) $46.33 Hour
Day Habilitation provider (social and human service assistants) $19.91 - $62.16 Hour
Mental health provider (Master's level clinical psychologist or licensed professional counselor, or Board-Certified $46.20 - $200 Hour

ANCHORAGE SCHOOL DISTRICT
ITS 2026-004 Individualized Educational Services
ATTACHMENT B
DESCRIPTION OF SERVICES AND FEE SCHEDULE
We, the undersigned, hereby submit our description of services and fee schedule as listed below to provide
INDIVIDUALIZED EDUCATIONAL SERVICES to the Anchorage School District.
General Category of Educational Service (Please check all that apply)
English Language Arts; Written Expression; Math; Use of Assistive Technology; Fine or Gross

Motor Skill Development; Social Skills; Adaptive Ed; Study Skills; Behavioral Skills;
Community, Transition or Vocational Skills.
Description of Individualized Educational Service Rate Unit of Measure
(As specified in attached rate sheet) (As specified in attached rate sheet)
Tutor, without teaching credential $24.58 Hour
Tutor, with teaching credential $45-60 Hour
SLP, providing therapy or social skills instruction $42.93 - $60 Hour
OT, proving therapy $46.33 Hour
BVI instruction, Orientation and Mobility (low vision
therapists) $46.33 Hour
Day Habilitation provider (social and human service
assistants) $19.91 - $62.16 Hour
Mental health provider (Master's level clinical psychologist
or licensed professional counselor, or Board-Certified $46.20 - $200 Hour
CURRENT PROFESSIONAL CERTI FICATIONS OR CREDENTIALS (IF ANY):
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Procurement Card (Credit Card) Use Acknowledgement (Check One): Authorized Not Authorized
PLEASE COMPLETE ALL INFORMATION BELOW
DATE:
CONTRACTOR/BUSINESS NAME:
CONTRACTOR'S SIGNATURE:
PRINTED NAME: PRINTED TITLE: ____________________________
ATTACHMENT B DESCRIPTION OF SERVICES AND FEE SCHEDULE Page 1 of 1

This page summarizes the opportunity, including an overview and a preview of the attached documents.
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