BHPM · Public Record|Agreement #25BHSOAC019|SCCOE Prime · IMPACTER PathwayYear 1 of 2 · 2026–27|Updated September 11, 2026|

Eighteen schools · six districts · four counties

The Record

The Cohort Readiness Tracker

Readiness was assessed school by school before any student saw the instrument. This is that record: for each of the eighteen participating schools, the grade span, where the assessment was made, the agreements behind it, the population it is administering to, its screening window and the technology it runs on. The assessment instrument itself follows, so the questions are visible alongside the answers.

18 schools6 districts4 counties18 of 18 assessed · 7 sections eachagreements as of 6 September 2026

18

Schools

6

Districts

4

Counties

18

Readiness Determinations Signed Off

18

Sites On Clever Single Sign-On

The Legal Ground

Agreements Across The Cohort

As Of 6 September 2026

Executed at all six LEAs, and therefore at all eighteen sites.

MOU With SCCOE

Executed

Memorandum of understanding between the county superintendent and the district.

Master Services Agreement

Executed

Master services agreement with Impacter Pathway, carrying the data processing terms.

CA-NDPA

Executed

California Student Data Privacy Agreement, version 1.5.

County

Where The Assessment Was Made

18 of 18 schools

Assessed On Site. The assessment workbook was completed on site with the school team and is filed against Deliverable 1.Assessed With The District. The assessment was completed with district technology, staffing and student services staff alongside the site team, and is filed against Deliverable 1.

Ventura County

Rio School District

MOU ExecutedMSA ExecutedCA-NDPA Executed

Rio School District: participating schools, grade spans, readiness assessment, agreements, target population, screening window and technology.
#	School	Grade Span	Readiness Assessment	Agreements	Target Population	Screening Window	Technology
1	Rio del Sol STEAM AcademyVentura County	K–8	Assessed On SiteAll Seven Sections · Signed OffRationale: On File	All Executed	3rd and 6th grade	Beginning of year, October, with a middle-of-year window to follow.	Q (Equitus) · Clever single sign-on · Clever rostering · 1:1, grades 3 to 5, Chromebooks
2	Rio Lindo ElementaryVentura County	K–5	Assessed On SiteAll Seven Sections · Signed OffRationale: On File	All Executed	3rd grade	Beginning, middle and end of year.	Q (Equitus) · Clever single sign-on · Clever rostering · 1:1, grades 3 to 5, Chromebooks
3	Rio Vista Middle SchoolVentura County	6–8	Assessed On SiteAll Seven Sections · Signed OffRationale: On File	All Executed	6th grade	Beginning of year, October, with a middle-of-year window to follow.	Q (Equitus) · Clever single sign-on · Clever rostering · 1:1, grades 3 to 5, Chromebooks

Santa Clara County

Mount Pleasant Elementary School District

MOU ExecutedMSA ExecutedCA-NDPA Executed

Mount Pleasant Elementary School District: participating schools, grade spans, readiness assessment, agreements, target population, screening window and technology.
#	School	Grade Span	Readiness Assessment	Agreements	Target Population	Screening Window	Technology
10	Robert Sanders ElementarySanta Clara County	K–5	Assessed On SiteAll Seven Sections · Signed OffRationale: On File	All Executed	3rd grade, plus counseling referrals	1 and 2 October, with a middle-of-year window in January or February.	PowerSchool · Clever single sign-on · Clever rostering · 1:1, iPads in K to 2 and Chromebooks in 3 to 5
11	August Boeger Middle SchoolSanta Clara County	6–8	Assessed On SiteAll Seven Sections · Signed OffRationale: On File	All Executed	6th grade, plus counseling referrals	1 and 2 October, with a middle-of-year window in January or February.	PowerSchool · Clever single sign-on · Clever rostering · 1:1, iPads in K to 2 and Chromebooks in 3 to 8
12	Ida Jew Academy and Valle Vista ElementarySanta Clara County	K–8 and K–5, co-located	Assessed On SiteAll Seven Sections · Signed OffRationale: On File	All Executed	6th grade, plus counseling referrals	1 and 2 October, with a middle-of-year window in January or February.	PowerSchool · Clever single sign-on · Clever rostering · 1:1, Chromebooks

Santa Clara County

Milpitas Unified School District

MOU ExecutedMSA ExecutedCA-NDPA Executed

Milpitas Unified School District: participating schools, grade spans, readiness assessment, agreements, target population, screening window and technology.
#	School	Grade Span	Readiness Assessment	Agreements	Target Population	Screening Window	Technology
13	Calaveras Hills High SchoolSanta Clara County	9–12, alternative	Assessed With The DistrictAll Seven Sections · Signed OffRationale: In The Deliverable 1 Record	All Executed	Whole school	Beginning of year, October.	Aeries · Clever single sign-on · Clever rostering · 1:1, Chromebooks and MacBooks
14	Milpitas High SchoolSanta Clara County	9–12	Assessed With The DistrictAll Seven Sections · Signed OffRationale: In The Deliverable 1 Record	All Executed	9th grade	Beginning of year, October.	Aeries · Clever single sign-on · Clever rostering · 1:1, Chromebooks and MacBooks
15	Rancho Milpitas Middle SchoolSanta Clara County	7–8	Assessed With The DistrictAll Seven Sections · Signed OffRationale: In The Deliverable 1 Record	All Executed	7th grade, the year before the eighth-grade transition, at a school serving grades 7 and 8.	Beginning of year, October.	Aeries · Clever single sign-on · Clever rostering · 1:1, Chromebooks

Santa Clara County

Sunnyvale School District

MOU ExecutedMSA ExecutedCA-NDPA Executed

Sunnyvale School District: participating schools, grade spans, readiness assessment, agreements, target population, screening window and technology.
#	School	Grade Span	Readiness Assessment	Agreements	Target Population	Screening Window	Technology
16	Lakewood Elementary SchoolSanta Clara County	K–5	Assessed With The DistrictAll Seven Sections · Signed OffRationale: In The Deliverable 1 Record	All Executed	5th grade, a baseline before middle-school entry.	Beginning of year, October.	PowerSchool · Clever single sign-on · Clever rostering
17	Columbia Middle SchoolSanta Clara County	6–8	Assessed With The DistrictAll Seven Sections · Signed OffRationale: In The Deliverable 1 Record	All Executed	The transition grade for this grade span, set with the site at administration design.	Beginning of year, October.	PowerSchool · Clever single sign-on
18	Sunnyvale Middle SchoolSanta Clara County	6–8	Assessed With The DistrictAll Seven Sections · Signed OffRationale: In The Deliverable 1 Record	All Executed	6th grade under active consent; 7th and 8th under passive consent.	Beginning of year, October.	PowerSchool · Clever single sign-on

San Diego County

San Diego Unified School District

MOU ExecutedMSA ExecutedCA-NDPA Executed

San Diego Unified School District: participating schools, grade spans, readiness assessment, agreements, target population, screening window and technology.
#	School	Grade Span	Readiness Assessment	Agreements	Target Population	Screening Window	Technology
4	Pacific Beach MiddleSan Diego County	6–8	Assessed With The DistrictAll Seven Sections · Signed OffRationale: In The Deliverable 1 Record	All Executed	The transition grade for this grade span, set with the site at administration design.	Fall 2026 beginning-of-year window.	PowerSchool · Clever single sign-on
5	Mission Bay High SchoolSan Diego County	9–12	Assessed With The DistrictAll Seven Sections · Signed OffRationale: In The Deliverable 1 Record	All Executed	The transition grade for this grade span, set with the site at administration design.	Fall 2026 beginning-of-year window.	PowerSchool · Clever single sign-on
6	Clairemont High SchoolSan Diego County	9–12	Assessed With The DistrictAll Seven Sections · Signed OffRationale: In The Deliverable 1 Record	All Executed	The transition grade for this grade span, set with the site at administration design.	Fall 2026 beginning-of-year window.	PowerSchool · Clever single sign-on

El Dorado County

Lake Tahoe Unified School District

MOU ExecutedMSA ExecutedCA-NDPA Executed

Lake Tahoe Unified School District: participating schools, grade spans, readiness assessment, agreements, target population, screening window and technology.
#	School	Grade Span	Readiness Assessment	Agreements	Target Population	Screening Window	Technology
7	South Tahoe High SchoolEl Dorado County	9–12	Assessed With The DistrictAll Seven Sections · Signed OffRationale: In The Deliverable 1 Record	All Executed	9th grade, at the middle-to-high transition.	Fall 2026 beginning-of-year window.	Aeries · Clever single sign-on
8	South Tahoe Middle SchoolEl Dorado County	6–8	Assessed With The DistrictAll Seven Sections · Signed OffRationale: In The Deliverable 1 Record	All Executed	6th grade, at the elementary-to-middle transition.	Fall 2026 beginning-of-year window.	Aeries · Clever single sign-on
9	Bijou Community SchoolEl Dorado County	K–5	Assessed With The DistrictAll Seven Sections · Signed OffRationale: In The Deliverable 1 Record	All Executed	3rd grade, at the transition from learning to read to reading to learn.	Fall 2026 beginning-of-year window.	Aeries · Clever single sign-on

The Instrument

What Was Actually Assessed

One workbook per school site. It documents technology, data, privacy, scheduling and behavioral health readiness ahead of platform deployment, and it is completed in a working session with the LEA and site team. Findings feed the Recruitment Outcomes Summary (Deliverable 1) and the Training and Technical Assistance Plan (Deliverable 3).

Seven sections, complete at all eighteen schools and reproduced below as the blank form is laid out. Where the form supplies a fixed response scale, the scale is shown; where it asks for an open answer, the guidance beside the input is shown instead. The eight-dimension rubric that decided which districts entered the cohort is a separate instrument, and it sits in Deliverable 1, Selection & Readiness.

A

Site Identification

Who the school is and who was in the room when the assessment was made.

LEA (District): The participating district.
School Name: The participating school.
Grade Span: For example, 6 to 8.
Site Administrator: Name, title and email.
Counselor Or Wellness Lead: Name and email.
LEA IT Contact: Name and email.
Assessment Date And Assessor: Date of the working session and the assessor who ran it.

B

School Profile

The population the screening window will reach, so findings can be read against who the school serves.

Enrollment, Current Year: Current-year enrollment.
Title I Status: Scale · Yes / No
Basic Aid LEA: Scale · Yes / No
School Model: Community school, traditional, or other.
Race And Ethnicity Summary: Top groups, as a percentage of enrollment.
English Learners: Share of enrollment.
Foster Youth: Share of enrollment.
Socioeconomically Disadvantaged: Share of enrollment.
Students With Disabilities: Share of enrollment.

C

Technology And Data

Whether the school can put students in front of the instrument, and whether rosters can reach it without hand entry.

SIS In Use: Scale · Aeries / PowerSchool / Infinite Campus / Synergy / Schoolwise / Other
Clever SSO Status: Scale · Live / District has Clever, school not provisioned / No Clever / Unknown
Rostering Path Confirmed, Nightly Sync: Scale · Yes / No / Needs IT meeting
Device Availability For Administration: For example, Chromebook carts or 1:1.
Student To Device Ratio: For example, 1:1.
Headphones And Microphones For Spoken Responses: Availability, for example class sets.
Network And Bandwidth: Any known constraint on the administration window.
Existing Screening Tools Or Wellness Surveys: What the school already runs, and how often.

D

Privacy And Agreements

The legal ground the data sits on before a single response is collected.

Across this cohort both agreement fields read executed at all six LEAs, as of 6 September 2026.

CA-NDPA Status, LEA Level: Scale · Executed / In signature / In review / Not started
Data Sharing Agreement Status: Scale · Executed / In signature / In review / Not started
Parent Notification And Consent Approach: For example, a passive notification letter on the district template.
Data Governance Notes: Roles and restrictions, for example aggregate-only access for the county office and site roles set by the access model.

E

Behavioral Health Capacity

Whether there is somewhere for a flagged student to go, which is the difference between screening and support.

Counseling And Wellness Staffing: Full-time equivalents by role.
MTSS Tier Structure In Place: Scale · Mature / Emerging / Not in place
Referral Pathway From Screening To Services: For example, a weekly student study team with a county school-linked services partner on site.
Current Data Practices For Goal Setting And Tracking: What data the school already reviews, and on what cycle.
BHSSA-Funded Services At This School: The services this school receives under the Behavioral Health Student Services Act.

F

Scheduling And Implementation

How the window actually runs in a school day, which is where most implementation risk lives.

Target Fall Screening Window: The dates the school will administer.
Administration Plan: Sessions, rooms and proctors.
Make-Up Plan: How students who miss the window are reached.
Training Dates Requested: Staff professional development dates the site asks for.
Implementation Support Needs: For example, a Spanish-language family letter, or a bell-schedule constraint.
Risks And Constraints: Anything the site names that the window has to work around.

G

Readiness Determination

The finding itself, and the conditions attached to it.

Overall Readiness Rating: Scale · Ready / Ready with conditions / Not yet ready
Conditions Or Actions Required Before Go-Live: What has to be true before the window opens.
Sign-Off Complete: Scale · Yes / No

✓

Sign-Off

Sign-off records that the site holds the information to be accurate and the school committed to the fall screening window. It is complete at all eighteen sites.

Site Administrator, principal or designee
LEA Lead, district behavioral health or student services
Impacter Pathway Assessment Lead

Source

Transcribed from BHPM_Site_Readiness_Assessment.xlsx, sheets “Cohort Tracker” and “Site Assessment”. Agreement status is as of 6 September 2026: the MOU, the master services agreement and the CA-NDPA are executed at all six LEAs, which is also what the district records carry. Several grade spans were stored as dates by the spreadsheet and are restored here from the district records. The workbook’s example row is not carried over.

Impacter Pathway assessment team · One workbook per school site, filed in the Deliverable 1 folder as LEA_SchoolName_Readiness_v1. · agreement #25BHSOAC019 · updated September 11, 2026

Every school here has a full record in the cohort. Open the districts and schools.