Texas PDSES

Service Provider Application

Two-Step Process

In order to receive payment from PDSES accounts, you will need to complete the following steps: First: Complete this application form, including uploading your credentials. Second: Because TEA is using ClassWallet to manage PDSES funds, after your application is approved, you will receive an email with a link to the ClassWallet website and the required next steps. Follow the instructions in that email to set up your ClassWallet account.

Help and Tips

For help entering your information and/or credentials through ClassWallet, contact help@classwallet.com or 877-969-5536. For questions about the PDSES program, contact us at pdsesproviders@region10.org. Be sure to whitelist "info@classwallet.com" and "automation@app.smartsheet.com"

Fees

All ClassWallet payments are subject to a 2.5% processing fee. Service providers are responsible for this fee and may not charge the fee to PDSES families.

Complete the required information:

Application Type*

NOTE: If you are an employee/volunteer of a Clinic/Company/Camp/Organization, please do not fill out an application for yourself. Your Clinic/Company/Camp/Organization will fill out an application which covers all employees/volunteers.

Enter the city where services are provided. If multiple cities are serviced, please list them separated by a comma (,). If the services are provided in a virtual environment, please type "Virtual".

Phone

If you do not have a website, please enter "none" in the box below.

Is this account for a summer camp?*

NOTE: Camps are required to upload a copy of their current, valid Texas DSHS or DFPS license.

•    Paraprofessionals and Special Education Assistants: You must upload either a current TEC certificate or documents/credentials (diploma, resume, etc.) demonstrating sufficient experience and training. •    Licensed/Certified Therapists: Services including speech therapy, occupational therapy, physical therapy, equine/horse therapy, music therapy, art therapy, aquatic therapy, ABA, recreational therapy, etc. If you provide a type of therapy/service that is licensed in Texas, you must upload a copy of your valid and active Texas license. If you provide a type of therapy that is NOT licensed in Texas, you must upload your credentials/certifications, and they will be evaluated on a case-by-case basis. •    Academic Tutor: You must upload a current, valid Texas Educator Certificate (TEC). •    Specialized Service: All services not listed above. Upload your credentials, resume, etc. and they will be evaluated on a case-by-case basis.

NOTE: Clinics, companies, and organizations are required to ensure that anyone personally providing direct services which are paid for by PDSES funds meets the criteria given for their appropriate category below. •    Paraprofessionals and Special Education Assistants: Each provider must have either a current TEC certificate or documents/credentials (diploma, resume, etc.) demonstrating sufficient experience and training. •    Licensed/Certified Therapists: Services including speech therapy, occupational therapy, physical therapy, equine/horse therapy, music therapy, art therapy, aquatic therapy, ABA, recreational therapy, etc. Each provider in a type of therapy/service that is licensed in Texas must have a valid and active Texas license. Each provider in a type of therapy/service that is NOT licensed in Texas must have credentials, certifications, education, and/or experience demonstrating the ability to provide the therapy or service competently and safely. •    Academic Tutor: Each provider must hold a current, valid Texas Educator Certificate (TEC). •    Specialized Service: All services not listed above. Contact pdsesproviders@region10.org for review of credentials on a case-by-case basis.

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Choose all that apply.

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(Type of service you provide)

Summer Camp Affirmation*

By checking "I agree" below, I hereby certify, on behalf of the organization that operates this camp: • that the license provided for services is authentic, truthful, and accurate. • that all health and safety standards for the services provided have been met. • that the services, facilities, staff and programs are adequately insured and policies are up to date. • that I have read, understand, and agree, on my own behalf or on behalf of the the organization that operates this camp, to the requirements for participation as an approved service provider in the Supplemental Special Education Services program. • that the organization that operates this camp takes full responsibility for all services provided and in no way holds Supplemental Special Education Services responsible for the events that occur at, during, or as a result of our service/program.

Do you personally have one or more children who are enrolled in the PDSES program?*
Do any employees/volunteers who will provide services for PDSES funds have one or more children who are enrolled in the PDSES program?*

By checking "I agree" below, I hereby certify, on behalf of the clinic/company/camp/organization:

  • Any staff members/volunteers who provide direct services which are paid for by PDSES funds do meet the criteria given for the appropriate category under "Service Provided," above.
  • All health and safety standards for all services provided have been met.
  • All employees/volunteers have passed background and safety checks.
  • The services, facilities, staff and programs are adequately insured and policies are up to date.

Upon approval of my application, I will, if requested, submit a set of fingerprints and authorize Texas Education Agency to conduct a background check at my own expense.

==NOTE: PDSES requires an eleven-digit Texas Taxpayer Number (aka Taxpayer ID)== Nine-digit numbers are usually Federal EIDs. PDSES can only accept eleven-digit Texas Taxpayer Numbers.

==NOTE: PDSES requires an Employer Identification Number (EIN), also known as a Federal Tax Identification Number, and is used to identify a business entity.

Click here to download the Service Provider Agreement: https://bit.ly/SSESOrg

Click here to download the Service Provider Agreement: https://bit.ly/SSESInd

Click here to download the Vendor Agreement: https://bit.ly/SSESVendors

If you are a clinic/company/camp/organization, you are required to upload: (1) Completed and signed Service Provider.


If you are an individual, you are required to upload (1) Certification/Credentials/License, etc. (2) Completed and signed Service Provider Agreement.


If you are a vendor, you are required to upload: (1) Completed and signed Vendor Agreement (2) State Business License

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If your certification does not have an expiration date (or if you do not have a license/certification), please put the expiration as 5 years from today's date.

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