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It defines the agreement purpose, partnership vision, and shared goals, and includes sections to document current services, eligibility and cost, schedules, staffing details, and contact information for both parties. 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All services will be provided to students with no out of pocket costs.  \nPlease also include:  \n• Other populations served (e.g. families, feeder schools, broader adolescent community.  \n• Any eligibility requirements/restrictions (e.g. services only available to students with Medi-Cal) .  \nSchedule  \nThe school-based health center will be open on the following dates and times:  \n___________________________________________________________________________________________________  \n___________________________________________________________________________________________________  \n___________________________________________________________________________________________________  \nPlease include any schedules that are specific to a certain service or program (e.g. medical, mental health, peer health education program, etc.)  \nThe health center is staffed by (Please include title and FTE for 2010-11 School Year, Name):  \n\n|  |\n| --- |\n|  |\n|  |\n\nContact Information of Both Parties  \nSite Administrator or Designated Liaison:   Main Phone Number:   Mobile Phone Number:   Designated Liaison (if different from Site Administrator):   Main Phone Number:   Mobile Phone Number:   Primary On-Site Contact at SBHC Partner Agency:   Main Phone Number:   Mobile Phone Number:   Alternate Contact at SBHC Partner Agency (e.g. Supervisor of SBHC Coordinator, Medical Director, etc.):  \nMain Phone Number:   Mobile Phone Number:    \nShared Goals and Objectives  \nFor the [YEAR] school-year the shared goals and objectives (e.g. outcomes, strategies, utilization, focus populations, etc.) for this partnership are:  \nExample 1) Increase utilization of health services by young men on campus by [XX%] to address the disparity between young men and women in accessing healthcare  \nExample 2) Screen [XX%] of school-based health center clients during visits for academic needs in order to provide appropriate support and referrals  \nExample 3) Implement Coordination of Services Team (COST) to increase referrals and case coordination between support service providers  \nExample 4) Increase professional development around health issues for school staff to a) improve staff wellness and, b) to increase school staff knowledge of how to identify health needs of students and when/where to refer students for services  \nExample 5) Conduct or arrange health education workshops for families in order to incre","cbCaig2hn4jP4rOq","https://ap.wps.com/l/cbCaig2hn4jP4rOq","pdf",176939,"English","# Purpose of Agreement\n# Vision\n# Description of Current Services\n# Eligibility and Cost\n# Schedule\n# Contact Information of Both Parties\n# Shared Goals and Objectives\n# Expectations of Both Parties\n## The School Will\n## Integration","[{\"question\":\"What is the purpose of the agreement template?\",\"answer\":\"The agreement outlines and formalizes the partnership and site-based agreements between the school and the partner agency for a community school-based health center.\"},{\"question\":\"What sections are included to describe services and operations?\",\"answer\":\"It includes description of current services, eligibility and cost, scheduling details, staffing information, and operational contact information for both parties.\"},{\"question\":\"How does the template define responsibilities for both parties?\",\"answer\":\"It lists shared goals and objectives and sets expectations, including logistics the school will provide and integration items such as participation in events and coordination of services.\"}]","Sample School-Based Health Center Letter of Agreement - Purpose, Services, and Responsibilities | PDF",1789492382]