MANSEF Functional Career Development Portfolio

MANSEF Functional

Career Development

Portfolio Counseling & Advisory Activities

Developed by

Amy Alvord, The Ivymount School

Dareen Barrios, Maryland School for the Blind

Sue Bennett, Bendictine School

Kelly Gealy, Maryland School for the Blind

Joshua Gervais, St. Elizabeth School

Sarah Martin, St. Elizabeth School

Sharon Nickolaus, The Ivymount School

David Quinn, Benedictine School

Valerie Smitheman-Brown, Kennedy Krieger LEAP Program

Resources gathered from:

Career and Technology Education, Maryland State Department of Education

Center for Career Development, Maine Community Colleges

Florida Department of Education

MANSEF Personnel

Office of Career and Technology Education, South Dakota State Department of

Education

About My Child… .............................................................................................................. 4

Things to Think About… .................................................................................................... 6

Student Profile .................................................................................................................... 7

Community Mobility Skills Profile .................................................................................. 23

Sample Student Interview Form ....................................................................................... 26

Vocational Critical Skills Checklist .................................................................................. 29

VOCATIONAL POINT SHEET ...................................................................................... 30

VOCATIONAL POINT SHEET II .................................................................................. 31

Work Card ......................................................................................................................... 32

Career Portfolio ................................................................................................................. 34

CAREER EXPLORATION ACTIVITY .......................................................................... 35

Future Planning Inventory ................................................................................................ 36

How Did My IEP Meeting Go .......................................................................................... 42

IEP Invite to Student ......................................................................................................... 46

IEP/Transition Meeting Checklist.................................................................................... 47

List of Rating Scales and Inventories ............................................................................... 48

Personal Goals for Transition ........................................................................................... 49

Personal Information ......................................................................................................... 51

Planning for the Future ..................................................................................................... 52

Preparing for My IEP Meeting ......................................................................................... 59

Student Letter of Invitation to IEP Meeting ..................................................................... 61

Student Preferences ........................................................................................................... 62

Student Skills and Abilities ............................................................................................... 66

SUMMARY OF SELF-AWARENESS INVENTORIES CAREER EDUCATION ....... 89

Things that are Important to Me ....................................................................................... 91

Transition Interview Questions ......................................................................................... 93

SURVEY OF INDOOR AND OUTDOOR RECREATIONAL ACTIVITIES ............... 96

FAMLY INTERVIEW FORM ......................................................................................... 99

Functional Life Plan-Staff Questionnaire ....................................................................... 114

Functional Life Plan Process .......................................................................................... 115

PARENT SURVEY ........................................................................................................ 121

Student Dream Sheet....................................................................................................... 123

Preferences and Interests................................................................................................. 126

Functional Life Plan-Parent Questionnaire ..................................................................... 127

Transition Services-Parent/Guardian Questionnaire ....................................................... 128

COURSE OF STUDY PLAN ......................................................................................... 131

FUNCTIONAL CAREER DEVELOPMENT PORTFOLIO ......................................... 132

PROGRAM FOR TRANSITION-PARENT SURVEY ................................................. 133

Career Cluster Collage .................................................................................................... 135

CAREER CLUSTER DESCRIPTIONS ......................................................................... 136

TRANSITION CAREER CLUSTERS ........................................................................... 138

REVIEW OF SKILLS CHECKLISTS ........................................................................... 140

INITIAL TRANSITION PLANNING ........................................................................... 141

Fine Motor/ Eye Hand Integration .................................................................................. 142

Imitation .......................................................................................................................... 143

Group Skills .................................................................................................................... 145

Social............................................................................................................................... 147

Cognitive/Readiness Skills ............................................................................................. 150

Expressive Communication ............................................................................................ 155

READINESS SKILLS CHECKLIST ............................................................................. 159

READINESS SKILLS CHECKLIST II ....................................................................... 161

READINESS SKILLS CHECKLIST III ....................................................................... 163

READINESS SKILLS CHECKLIST IV ...................................................................... 165

Interview Questions ........................................................................................................ 167

GROUP SKILLS CHECKLIST ..................................................................................... 169

SOCIAL SKILLS CHECKLIST..................................................................................... 171

VOCATIONAL SKILLS CHECKLIST ......................................................................... 173

School Based (C) 8, 9, 10, 11, 12 (Circle One)

Student: ________________________________________________

About My Child…

Parents, please take a few moments to think about your child and answer these questions.

Describe your child:____________________________

___________________________________________

___________________________________________

___________________________________________

___________________________________________

What are your dreams for your child?

(List them no matter how big they are.) _____________

___________________________________________

___________________________________________

___________________________________________

___________________________________________

What are your fears for your child? _______________

___________________________________________

___________________________________________

___________________________________________

___________________________________________

What are your child’s strengths? __________________

___________________________________________

___________________________________________

___________________________________________

___________________________________________

___________________________________________

What are your child’s needs? _____________________


Student: ________________________________________________

___________________________________________

___________________________________________

___________________________________________

___________________________________________

List at least three things you would like your child to

work on during the upcoming school year:

1. _________________________________________

_________________________________________

2. _________________________________________

_________________________________________

3. _________________________________________

_________________________________________

“Let not our needs determine our dreams…

but let our dreams determine our needs.” Colleen F. Tomke

Keep the focus of your vision on your child’s strengths

and interests. Think about the things in life that you value and

would like your child to have. Most people value their

relationships with others and being an active member of society.

We also tend to value being able to pursue things we are good at

and using them for something meaningful and purposeful.


Student: ________________________________________________

Things to Think About…

Please mark all areas of interest or concern. LIFE SKILLS

Using basic appliances & tools

Maintaining house and grounds

Fitness/wellness/nutrition

Appropriate dress

Personal hygiene/grooming

Social skills

Safety

Sex education

Marriage, children, parenting

Preparing & consuming food

Care of clothing

Laundering of clothing

Household cleaning

Shopping

Money management

Care of medical condition

Other _____________________

SOCIAL SKILLS Handling praise & critcism

Knowledge of physical self

Self-confidence

Aware of emotions

Respect for others

Respect for authority

Appropriate behavior in public

Honesty

Developing friendships

Listening & responding

Other _____________________

HOUSING OPTIONS Live Alone Live with roommate Live with existing family Live with other family member Apartment House Supervised apartment/house Host home Group Home Other _____________________

CAREER/EMPOYMENT Full/Part-time regular job

(Competitive Employment) Full/Part-time (Supported Employment)

Self Employment Volunteer Work Sheltered Workshop Military Service Other _____________________

EMPLOYMENT DEVELOPMENT Awareness of job possibilities

Understanding personal strengths

& areas I need to work on

Being mindful of work habits

Appropriate behaviors

Finding & keeping a job

Knowing appropriate dress

Other _____________________

Counseling & Advising (A) 8, 9, 10, 11, 12 (Circle one)

Maryland School for the Blind Career Education Program

Student Profile Update: 10/6/05

To be completed by: CEP Staff Frequency & Timeframe: Initial Intake to CEP, then updated annually

Student Name: First, Middle and Last

Date Completed:

Age of Student: Age 14

Age 15

Age 16

Age 17

Age 18

Age 19

Age 20

Age 21

Completed by:

Personal Information

Demographics

First Name:

Middle Name:

Last Name:

Nickname or Commonly Used Name:

Current Address: Street number and name

Building number

Apartment number

City

State

Zip code

Current Telephone:

Current E-mail:

Social Security Number:

Date of Birth:

Gender: Male

Female

Personal Contacts

Student Profile

8

List the primary (most important) contacts for the student and indicate their relationship to the student. Many primary contacts will be Make as many copies of this page as are needed to complete the personal contact information. Mark them Page 2 – a, 2 – b, etc. (Maximum of 15 contacts allowed in database.)

Name

Current Address: Street number and name

Building number

Apartment number

City

State

Zip code

Current Telephone:

Current E-mail

Place of Employment: (For immediate family members, if known)

Relationship of Legal Guardian to Student:

Mother Birth

Adoptive

Foster

Father Birth

Adoptive

Foster

Brother

Sister

Aunt

Uncle

Grandfather

Grandmother

Friend

Other (define):

Page 2 - ___ of ___ (total # of additional page 2‘s)

Student Profile

9

Legal

Student is his/her own legal guardian

Yes

No

Name of Legal Guardian:

Relationship of Legal Guardian to Student:

Mother

Father

Brother

Sister

Aunt

Uncle

Grandfather

Grandmother

Other (define):

Legal Guardian‘s Home Address:

Street # and Name:

Building #:

Apartment or Suite #:

City or town:

State:

Zip Code:

Home Telephone:

Work Telephone: Mobile Telephone:

Student has state or other ID card:

Yes Describe:

No

Student is registered to vote

Yes

No Eligible but not registered

Not of age

Home County

Home State:

Home County:

Home County Address:

Street # and Name:

Building #:

Apartment or Suite #:

City or town:

State:

Zip Code:

Home County Telephone:

Student Profile

10

Benefits

Social Security – SSI (Supplemental Security Income)

Yes Amount per month: $

No Never applied

Application pending Date:

Application denied Date:

Social Security – SSDI (Social Security Disability Income)

Yes Amount per month: $

No Never applied



Medicaid Yes Number:

No Never applied



Medicare Yes Number:

No Never applied



Private Insurance Yes Company:

Policy #:

Policyholder:

Type of Coverage:

None

Student Profile

11

Health And Medical Information

Medications

List all medications required by the student (including PRN). Update this section as frequently as needed using notifications from Health Services. Make as many copies of this page as are needed to complete the medication information. Mark them Page 5 – a, 5 – b, etc. (Maximum of 15 medications allowed in database.)

Medication:

Purpose:

Dose:

Schedule:

Potential Side Effects:

Student can self-medicate:

Yes

No

Assistance required:

Medication:

Purpose:

Dose:

Schedule:



Yes

No


Medication:

Purpose:

Dose:

Schedule:



Yes

No



Student Profile

12

Environmental Restrictions

List all restrictions for the student (including temporary). Update this section as frequently as needed using notifications from Health Services or other sources.

Heat Yes Maximum time:

Maximum temperature:

Protective gear needed:

Date imposed:

Date lifted:

No

Cold Yes Maximum time:

Minimum temperature:


Date imposed:

Date lifted:

No

Air quality Yes Maximum time:

Maximum air quality rating:


Date imposed:

Date lifted:

No

Sunlight Yes Maximum time:


Date imposed:

Date lifted:

No

Other: Yes Maximum time:


Date imposed:

Date lifted:

No

Physical Activity Restrictions

Student Profile

13

List all restrictions for the student (including temporary). Update this section as frequently as needed using notifications from Health Services or other sources.

Bending Yes Maximum time:


Date imposed:

Date lifted:

No

Lifting Yes Maximum weight:


Date imposed:

Date lifted:

No

Standing Yes Maximum time:


Date imposed:

Date lifted:

No

Kneeling Yes Maximum time:


Date imposed:

Date lifted:

No

Sitting Yes Maximum time:


Date imposed:

Date lifted:

No

Other: Yes Maximum time:


Date imposed:

Date lifted:

No

Medical Conditions

Student Profile

14

List all conditions for the student (including temporary). Update this section as frequently as needed using notifications from Health Services or other sources. Make as many copies of this page as are needed to complete the medical condition information. Mark them Page 8 – a, 8 – b, etc. (Maximum of 6 conditions allowed in database.)

Include seizures, allergies and other conditions in this area.

Condition:

Type: Chronic

Temporary Start date:

End date:

Impact of condition:

Restrictions resulting from condition:

Complete any restrictions in the ―environmental‖ or ―physical activity‖ restrictions section.

Medications resulting from condition:

Complete any medications in the ―medications‖ section.

Condition:

Type: Chronic


End date:






Condition:

Type: Chronic


End date:







Student Profile

15

Health Skills

Can take routine medications at work (e.g. knows when and how to use medication, understands and follows medication schedule, plans ahead for taking medication at work, etc.)

Yes

No

Can take PRN (as needed) medications at work (e.g. knows when and how to use medication, understands and follows medication schedule, plans ahead for taking medication at work, etc.)

Yes

No

Physical activity restrictions Bending

Lifting Max weight (lbs)

Standing

Kneeling

Sitting

Walking:

Other:

Accommodations Needed

Student Profile

16

Self-Care Information Eating Check all that apply except if “independent” is checked.

Independent (Do not check any other fields in this area.)

Requires partial physical assistance (e.g. set up

plate and utensils)

Describe:

Requires full physical assistance

Uses feeding tube

Requires adaptive eating equipment (e.g. adaptive

utensils)

Describe:

Requires special food preparation (e.g. pureed)

Describe:

Drinking Check all that apply except if “independent” is checked.


Requires partial physical assistance

Describe:


Requires adaptive drinking equipment

Describe:

Specific fluid requirements (e.g. no ice)

Describe:

Student Profile

17

Grooming and Hygiene (Check all that apply except if “independent” is checked.)

Independent in all grooming skills below (Do not check any other fields in this area.)

Showering or bathing

Independent (no assistance required)

Requires support

Describe:

Shampooing hair


Requires support

Describe:

Applying deodorant


Requires support

Describe:

Shaving Independent (no assistance required)

Requires support

Describe:

Hair styling Independent (no assistance required)

Requires support

Describe:

Applying make-up


Requires support

Describe:

Showering or bathing


Requires support

Describe:

Menstrual care


Requires support

Describe:

Student Profile

18

Toileting Check all that apply except if “independent” is checked.



Describe:


Uses Depends/Attends

Requires adaptive equipment (e.g. wheelchair accessible stall and sink)

Describe:

Dressing Check all that apply except if “independent” is checked.



Describe:


Requires adaptive equipment or clothing (e.g. Velcro closures)

Describe:

Student Profile

19

Behavior Information Behaviors of Concern

Student has Behavior Management Plan

Yes

No

In development

Student has behaviors of concern (even if no BMP)

No

Yes (Complete list below.)

Antecedent(s) to behavior What happens before?

Behavior exhibited What is specific behavior?

Appropriate response What response is effective?

Consistent Environmental Restrictions (Due to Behaviors) Check all that apply.

Noise Describe specifics:

Gender of coworkers Males problematic

Females problematic

Space Describe specifics:

Illness Describe specifics:

Other: Describe specifics:



Student Profile

20

Funding And Service Information State Funding and Services

DDA (Developmental Disabilities Administration)

Yes Regional Office: Central

Eastern Shore

Western

Southern

Telephone #:

Address:

Services Requested:

Supported Employment

Day Habilitation

CSLA

Residential

Family/Individual Support Services

Date Case Opened:

No Never applied



DORS (Division of Rehabilitation Services)

Yes Counselor Name:

Office:

Telephone:

Case #:

Date Case Opened:

No Never applied



Resource Coordination

Yes Coordinator Name:

Office:

Telephone:

Case #:

Date Case Opened:

No Never applied



Student Profile

21

Federal Funding and Services

Medicaid Waiver Yes Services waivered:

Supported Employment

Day Habilitation

Residential

CSLA

No Never applied



MSB Services Information Key Dates

Date of admission to MSB:

Day:

Month:

Year:

Projected graduation date:

Month:

Year:

Program

Early Childhood Date of admission:

Date of transfer:

Reason for transfer:

EAP (Expanded Academics Program)

Date of admission:

Date of transfer:


LIFE team Date of admission:

Date of transfer:


SOLAR Date of admission:

Date of transfer:


Student Profile

22

Residential Date of admission:

Date of transfer:


MSB Address:

Telephone:

Primary Contact:

Primary Contact Telephone:

Services Check all that apply.

Occupational Therapy Primary Contact:

Physical Therapy Primary Contact:

Speech Therapy Primary Contact:

Orientation and Mobility Primary Contact:

Psychology Primary Contact:

Technology Primary Contact:

Social Work Primary Contact:

Disability Information

Primary Disability: Blindness

Visually Impaired

Secondary Disability: Mental retardation

Hard of hearing

Speech-Language

Emotional disturbance

Orthopedic impairment

Other health impairment

Specific learning disability

Multiple disabilities

Deaf-blindness

Traumatic brain injury

Autism

Counseling & Advisory (A) 8, 9, 10, 11, 12 (Circle One)

Moon, Hernandez & Neubert (2003) 23

Community Mobility Skills Profile

Name of Student:_______________________________ Date:___________________

General Mobility Yes No Not Observed Comments

1. Walks without difficulty

2. Climbs steps without difficulty

3. Uses elevators & escalators

without difficulty

If no, give details:

______________________________________________________________________________

______________________________________________________________________________

4. Uses a wheelchair

a. Uses manual wheelchair

b. Uses electric wheelchair

c. Uses manual on most surfaces

without help

d. Transfers to car without help

e. Transfers to car with help

f. Uses elevator without help

g. Uses elevator with help

If yes, describe level of independence:_________________________________________________

________________________________________________________________________________

Street Crossing/Pedestrian Skills Yes No Not Observed Comments

1. Safely crosses street independently

a. One lane

b. Two lanes

c. Three lanes

2. Safely crosses non-controlled

intersections

3. Safely crosses with light signal

a. Person/Hand



b. Walk/Don’t Walk

Travel Skills Yes No Comments

1. Knows community safety

2. Uses exact change

3. Uses travel farecard independently

4. Tells time

5. Reads route sign in front of bus

6. Matches colors independently

7. Matches numbers independently

8. Recognizes outstanding building

and landmarks

9. Demonstrates appropriate social

bus riding skills (remains seated,

speaks in a normal voice, does not

interact inappropriately with bus

drivers or others)

10. Asks for assistance/uses phone in

emergency

11. Follows 1-2 step directions

12. Has an official state ID card

13. Has unofficial form of ID

14. Describe how the student communicates, indicating any assistive devices used or other means

of communication (i.e. ASL):_______________________________________________________

_______________________________________________________________________________

Bus/Rail

1. Individual lives within __________ blocks of a rail/bus/accessible van stop.

2. Bus/van route that stops closest to home ____________________________________

3. Can get to rail/bus/van stop by self

4. Can get a ride to bus/rail/van stop

Taxi/Paratransit Yes No

1. Can locate the phone numbers of three local cab companies and the

paratransit provider

2. Can dial the numbers of three local cab companies and ask for a cab to

specific location



3. Can ask someone to call cab for ride to specific location

Bicycle Yes No

1. Can ride bicycle independently

2. Can ride bicycle correctly following safety procedures and traffic/laws (i.e.

rides with traffic, obeys lights)

Driving

1. Can develop the reading, reasoning and motor skills necessary to drive

2. Parents desire that student learns to drive

3. Understands accommodations and adaptations available for drivers with

disabilities

4. Is eligible for driver’s education course

5. Has financial resources to get training and apply for license

Counseling and Advisory (A) 8,9.10,11,12 (circle one)

(continues) 26

Name: _______________________________________ Date: ___________________

Sample Student Interview Form

DIRECTIONS: Interview the student and record responses.

ATTITUDE TOWARD DISABILITY

!. Tell me about your disability.

2. Are you in a special education program? Which one? Why?

3. How do you feel about this program? Is it helpful?

B. INTERESTS IN LEISURE ACTIVITIES

!. What do you do in your spare time? Sports? Hobbies? Church?

Extracurricular clubs at school?

2. What chores do you do at home?

3. Do you have friends? What do you and your friends do together?

4. On a perfect Saturday, what would you do?

C. FAMILY RELATIONSHIIIPS

1. What do you like best about your family?

2. Who usually helps you with schoolwork or other problems?

3. Is there anything that causes difficulties for you at home?

D. FUNCTIONAL SKILLS

1. If you had a job, how would you get to work?

2. Who selects your clothes?

3. Do you shop alone for your personal things?

4. Do you have an allowance of personal money from a job?


(continues) 27

5. If you were home alone at dinner time, what would you eat and what would

you do to prepare this meal?

6. If you had $1000, what would you buy?

E. EDUCATIONAL INTERESTS

1. What classes would you like to take? Would you like to include vocational

classes?

2. Of all the classes you have taken, which one was the best? Why?

3. Do you want to go to school after high school?

4. What do your parents want you to do after high school?

F. WORK AND CLASS PREFERENCES

1. What teachers do you like best? Why? Least? Why?

2. Do you like to work alone or in a group?

3. When you work, do you like to sit most of the time or move around?

4. Do you prefer to work inside or outside?

5. Do you like to work on a computer?

6. Do you like to help people? Or work with things?

G. OCCUPATIONAL AND CAREER AWARENESS

1. Name as many jobs as you can. (time limit: 2 minutes)

2. Where do you begin to find a job?

3. What are some reasons people get fired?

4. What should you do if you are going to be absent or late to work?


(continues) 28

H. FUTURE PLANS

1. What will you be doing during the next year, in 5 years, in 10 years toward the

following postschool outcomes?

Employment:

Education:

Living Arrangements:

2. Will you need help meeting your goals? Which one(s)?

3. Where would you get the help you need?

4. What concerns you most about the future?


(continues) 29

Vocational Critical Skills Checklist Student : Date of Report:

D.O.B.: Completed by: D.Quinn/

Grad. Year: Work Experience:

Comments (Strengths, Needs, etc.):

Goals and Objectives:

Motivators:

Interfering Behaviors:

Critical Skill Areas

Continuous prompting

throughout the sequence

(1)

(25%)

Less prompting

for acquisition/

still requires

continuous

monitoring

(2)

(50%)

Higher level skill acquisition with intermediate monitoring

(3)

(75%)

Supervision out of

visual field

(Independent)

(4)

(100%)

1. Work Performance

a) Work quality

b) Rate

c) Initiative

d) Stamina

e) Generalization Skills

2. Behavior

a) Appropriate self-control

b) Ability to accept changes in routine

c) Appropriate interactions with others

3. Interpersonal Skills

a) Response to constructive criticism

b) Leisure and break skills

4. Communication Skills

a) Ability to express wants and needs

b) Requests assistance when needed

c) Ability to talk about self appropriately

d) Expressive communication skills

1) Simple

2) Complex

e) Receptive communication skills

1) Simple

2) Complex

5. Self-Help-Skills

a) Personal hygiene skills

b) Manners

c) Appropriate dress

d) Bathroom use

6. Motor Skills

a) Gross motor skills

b) Fine motor skills

7. Travel Skills

a) On school grounds

b) Public Transportation


(continues) 30

Name:

Rules: 1. Finishing Task 3. Walk in school

2. Stay with group 4. Keep self to self

Date:__________

VOCATIONAL POINT SHEET

Time Activity Rules Followed

8:00 a.m.

Arrival/Hygiene/Breakfast 1 2 3 4

8:30 a.m.

Morning Meeting 1 2 3 4

9:00 a.m.

Recreation & Leisure 1 2 3 4

9:30 a.m.

Movement & Music 1 2 3 4

10:00 a.m.

Purchasing Group 1 2 3 4

10:30 a.m.

Recreation & Leisure 1 2 3 4

11:00 a.m.

Movie 1 2 3 4

11:30 a.m.

Music 1 2 3 4

12:00 p.m.

Lunch 1 2 3 4


(continues) 31

Name:

Rules: 1. Finishing Task 3. Walk in school

2. Stay with group 4. Keep self to self

Date:__________

VOCATIONAL POINT SHEET II

Time Activity Rules Followed

8:00 a.m.

1 2 3 4

8:30 a.m.

1 2 3 4

9:00 a.m.

1 2 3 4

9:30 a.m.

1 2 3 4

10:00 a.m.

1 2 3 4

10:30 a.m.

1 2 3 4

11:00 a.m.

1 2 3 4

11:30 a.m.

1 2 3 4

12:00 p.m.

Lunch 1 2 3 4


(continues) 32

Name: Date:

Work Card

= Goal Met =Goal Not Met Do NOT Draw

Line Thru

Use Straight if goal

not attempt-

2 points 0 points Faces ed or

required

Mon Tue

Wed Thurs Fri

General Behavior and Attitude:

3= GREAT--How you want them to behave all of the

time

2= GOOD --Did pretty well, but needs some

improvement

1= FAIR --Needs much improvement in behavior

and attitude

0= Poor --Unacceptable or inappropriate behavior

Total Daily Points:


(continues) 33

Name: Date:

= Goal Met =Goal Not Met Do NOT Draw

Line Thru

Use Straight if goal

not attempt-

2 points 0 points Faces ed or

required

Mon Tue

Wed Thurs Fri

General Behavior and Attitude:

3= GREAT--How you want them to behave all of the

time

2= GOOD --Did pretty well, but needs some

improvement

1= FAIR --Needs much improvement in behavior

and attitude

0= Poor --Unacceptable or inappropriate behavior

Total Daily Points:


Name: __________________________________________ Date: __________________

Career Portfolio Directions: Evaluate the student, using the rating scale on the right. Circle the appropriate number to

indicate the degree of competency. The rating for each of the tasks should reflect job readiness rather than

the grade given in the class.

EMPLOYABILITY SKILLS (Competencies that will enable the individual to obtain and retain a job; base

scores on what individual is able to do without any supports.)

SCALE

The student can: Never 25% 50% 75% Always

1. Establish realistic career goals/choices N 1 2 3 4

2. Display a positive attitude toward work (work ethic) N 1 2 3 4

3. Demonstrate a good record of attendance N 1 2 3 4

4. Display punctuality at school, work, and following breaks N 1 2 3 4

5. Display a pride in work N 1 2 3 4

6. Demonstrate honesty N 1 2 3 4

7. Demonstrate dependability N 1 2 3 4

8. Observe and follow classroom/work rules and regulations N 1 2 3 4

9. Display initiative (e.g., begin work without being asked,

assume additional responsibility, help others voluntarily) N 1 2 3 4

10. Work at a consistent pace N 1 2 3 4

11. Manage time appropriately N 1 2 3 4

12. Demonstrate work stability (remains on the job/task until completed) N 1 2 3 4

13. Work effectively under pressure or within time limits N 1 2 3 4

14. Keep work area clean N 1 2 3 4

15. Display respect for other people N 1 2 3 4

16. Show respect for property of others N 1 2 3 4

17. Seek help when needed N 1 2 3 4

18. React appropriately to constructive criticism N 1 2 3 4

19. Accept praise appropriately N 1 2 3 4

20. Assume responsibility for own actions/behaviors N 1 2 3 4

21. Demonstrate appropriate reactions to own mistakes

(e.g., acceptance, correction) N 1 2 3 4

22. Demonstrate appropriate problem-solving skills (e.g., identify

problem, list possible solutions, select a solution, evaluate results) N 1 2 3 4

23. Demonstrate willingness to learn new skills/information N 1 2 3 4

24. Demonstrate adaptability to charging situations N 1 2 3 4

25. Follow safety regulations N 1 2 3 4

26. Respond appropriately to classroom and/or job related emergencies N 1 2 3 4

27. Practice good hygiene/grooming N 1 2 3 4

28. Dress appropriately for work/specific job N 1 2 3 4

29. Correctly complete a job application N 1 2 3 4

30. Demonstrate appropriate job interviewing skills N 1 2 3 4

N 1 2 3 4


CAREER EXPLORATION ACTIVITY

Student Name: Date:

CAREER SPEAKER FORM

Speaker’s Name:

Speaker’s Job Title:

Student attended to the presentation

Student participated in the activity presented

Student asked questions

Student was able to maintain appropriate behavior during the presentation

Signature

Counseling & Advisory 8, 9, 10, 11, 12

(Circle One)

36

Future Planning Inventory__________________________

Parent/Guardian Form Please complete this future planning document and bring it to the upcoming Individual Education Planning conference scheduled for your son/daughter.

General Student Information

Student‘s name: ____________________________________________________________

first middle last

Social Security number: _______________________ Birthdate: _____________________ Anticipated graduation date: ____________________ Grade: ________________________

Current address: _____________________________ Phone number: _________________ Parent‘s name: _______________________________ Parent‘s business phone: _________ What kind of secondary curriculum do you feel best meets the needs of your son /daughter? ________ College preparatory ________ General education ________ Vocational I. Vocational/Postsecondary Education Options A. Upon graduation, what do you see your son/daughter doing for future education or training? (Please check all that apply) ________ Four-Year college/university ________ Private occupational training program ________ Community college ________ Military service ________ Technical college ________ Community education program What will your son/daughter be studying or training to be? __________________________________________________________________________ My son‘s/Daughter‘s level of motivation to succeed in the academic setting: ________ high ________ medium ________low The level of control my son/daughter believes he or she has over decision making and his/her individual success: ________high ________medium ________low My son‘s/daughter‘s ability to identify what he/she needs and how to get it: ________high ________medium ________low B. Upon graduation, in what kind of employment setting do you see your son/daughter engaged in? ________ Competitive employment: ________ Full-time ________ Part-time ________ Self-employment ________ Supported employment: ________ Full-time ________ Part-time ________ Sheltered employment: ________ Full-time ________ Part-time


(Circle One)

37

C. What type of job/occupation do you see your son/daughter working in one year after graduation? _______________________________________________________________________ D. What type of job/occupation do you see your son/daughter working in five years after graduation? _______________________________________________________________________ E. What work-related demands are being placed on your son or daughter at home, and what is his or her reaction to them? Activity Degree of Independence

(For example makes bed, carries out trash, mows lawn.)

Does Independently

Needs Guidance

Unwilling to Perform Task

1.

2.

3.

4.

5.

F. List any jobs or chores your son/daughter does now and enjoys. _______________________________________________________________________ _______________________________________________________________________ G. What jobs or work experience has your son/daughter had in your community? ____________________________ ________________________________ ____________________________ ________________________________ H. List any jobs your son/daughter seems to really dislike. ____________________________ ________________________________ ____________________________ ________________________________

II. Home Living Options A. Where do you think your son/daughter will likely live after graduation? (Please check one from this list.) __________ Large urban (100,000 population plus) What city? ________________ __________ Urban (30,000 to 100,000 population) What city? ________________ __________ Rural (under 30,000 population What town? _______________ __________ Farm B. (Please check one from this list.) __________Live independently in apartment or home Where? ___________________ __________ With family member Who? ____________________ __________ With support __________ Supervised apartment (which one?) _____________________ __________ Group home (which one?) ____________________________


(Circle One)

38

__________ College dormitory Where? _________________________ __________ Other, please describe __________________________________________ III. Recreational and Leisure Options A. Leisure Interest Inventory Check all of the following leisure activities in which your son or daughter currently spends free time. Athletic/Sports Activities ______ swimming ______ lifting weights ______ skiing ______ running ______ aerobics ______ canoeing ______ softball ______ basketball ______ riding motorcycle ______ walking ______ fishing ______ camping ______ riding bike ______ bowling ______ riding horses ______ other ______________________________________________ Large Group Events ______ movies ______ car races ______ ball games ______ horse, dog, car shows ______ music events ______ community education classes ______ other ___________________________________________________ Individual Activities ______ sewing ______ listening to music ______ Internet ______ handcrafts ______ cooking ______ shopping ______ reading ______ playing instrument ______ playing pool ______ caring for pets ______ writing letters ______ caring for lawn ______ talking on phone ______ watching TV ______ playing video ______ clean/repair car games ______ other ____________________________________________________________ Social Activities ______ dating ______ entertaining at home ______ attending church ______ picnicking ______ volunteering ______ belonging to a social club ______ eating out ______ driving around ______ spending time with family ______ dancing ______ other _________________________ or friends B. In which extracurricular activities would you like your son/daughter to participate during

high school? _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Does your son/daughter need any specific supports or accommodations to participate in

this/these extracurricular activities? __________ Yes __________ No If yes, please describe: _____________________________________________ C. Future Leisure Activities Check any of the following leisure activity resources that are available in the community where you think your son/daughter will live following graduation: ______ YMCA OR YWCA ______ bowling leagues ______ recreation clubs, classes ______ city/county/state parks ______ movie ______ sports arenas ______ city recreation facilities ______ church groups ______ community ed center ______ other ___________________________________________________________


(Circle One)

39

Please list all the community leisure activities in which you hope your son/daughter will choose to participate after high school. __________________________________________________________________________

____________________________________________________________________________________________________________________________________________________ Does your son/daughter need any specific supports or accommodations to participate in these leisure activities? __________ Yes __________ No If yes, please describe: _______________________________________________________

IV. Transportation Options How will your son/daughter get around the community and to work? __________ drive own vehicle __________ drive family vehicle __________ use city bus transportation __________ take taxi __________ ride bicycle __________ walk __________ use special regional transportation system (i.e., bus between towns) __________ depend on others __________ other _________________

Does Now

Needs to Learn


(Circle One)

40

Are you willing to drive your son/daughter to work? __________ Yes __________ No How many miles? ___________________________________________________________

V. Financial Support A. Does your son/daughter need financial assistance in any of the following areas to reach his/her long-range goals? 1. Postsecondary education __________ Yes __________ No If yes, please check all of the following for which you would like information. __________ a. Division of Rehabilitation Services (DRS) __________ b. Pell Grants __________ c. Scholarships __________ d. Work study __________ e. Student loans __________ f. Supplemental Security Income (SSI) __________ g. Social Security Disability Insurance (SSDI) 2. Employment assistance __________ Yes __________ No If yes, please check all of the following for which you would like information. __________ a. Division of Rehabilitation Services (DRS) __________ b. Local Job Training Agency __________ c. State Job Service __________ d. Supplemental Security Income (SSI) __________ e. County social services __________ f. Rehabilitation centers 3. Home living assistance __________ Yes __________ No If yes, please check all of the following for which you would like information. __________ a. County Social Services __________ b. Supplemental Security Income (SSI)/medical assistance __________ c. Housing assistance—city government __________ d. Independent Living Center services B. Which of the following agencies have you contacted with regard to financial support for your son or daughter? __________ Not applicable __________ Division of Rehabilitation Services (DRS) __________ Local Job Training Agency __________ Social Security Office __________ County Social Services __________ Other, please describe __________________________________________ VI. Health-Related Needs A. When was the last physical examination completed for your son or daughter? (Date) ____________________ B. Does you son/daughter currently have any of the following needs? __________ medical (i.e., medications) __________ yes* __________ no __________ counseling __________ yes* __________ no __________ other ________________________________________________________ *Please explain __________________________________________________________ C. What are some supports your son/daughter may require in the future?


(Circle One)

41

_______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ VII. Currently, what is your greatest concern for your son/daughter‘s future? _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________


(Circle One)

42

How Did My IEP Meeting Go?

I worked hard to get ready for the IEP meeting by

learning to speak up for myself and being a good team member.

After the meeting is over, look at the following checklist to decide if the meeting went well.

Yes No

Were all the people I wanted at the meeting?

Was I introduced to everyone I did not know?

Did I get to ask questions?

Did other team members ask me what I thought?

Did I get to talk about the things I like to do and what I want for the

future?

Did the other team members listen to what I said?

Did I and my family, friends and advocates help decide on what was in

my IEP?

Does my program/IEP have goals for all the things I think are

important?

Do I like my IEP?

If you checked YES in most of the boxes on this page your IEP

should be just what you wanted.

If you checked a lot of NO’s, then you might need to talk to your

parents or school team member to let them know there are areas where

you have questions or that need some work.


(Circle One)

43

What goals will I be working on this year?

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

What 3 things did I like best about the meeting?

1.

2.

3.

What do I wish had been different about the meeting?

1.

2.

3.


(Circle One)

44

How Do I Know If My IEP is Working?

Circle Yes or No for each question

Am I making progress on learning what I need to know before

I finish school?

Yes No

Am I receiving the help I am supposed to receive Yes No

Have I had experiences that I have made me have new ideas

about what I want?

Yes No

Does my IEP need to change? Yes No

Will I have new goals? Yes No

Will I need new services? Yes No

Will I be able to get what I need when I graduate? Yes No

Am I learning what I need to know to become more

independent?

Yes No

Do I like the classes I am taking? Yes No

Am I learning new things? Yes No

Am I learning how to do things in the community? Yes No

Am I learning how to be friends with my classmates? Yes No

Am I learning how to be friends with my coworkers? Yes No

What has changed?

Are there changes I would like to make with my IEP? What are they?


(Circle One)

45

Counseling & Advisory (B) 8, 9, 10, 11, 12 (circle one)

46

IEP Invite to Student

Insert Date

Dear ________________________:

Your IEP planning meeting plays an important role in getting ready for your

future. And since it is YOUR future that is discussed during this meeting,

you are welcome and encouraged to attend. This is a time when your

teachers, therapists and parents all come together to talk about the progress

you have made this year and decide on the goals you will work on during the

next IEP cycle. Your opinion is VERY important!

Your IEP planning meeting will be ______________________ at

_____________. Please talk with Mom and Dad about being a part of this

important meeting. I hope you will be able to attend.

Sincerely,


47

IEP/Transition Meeting Checklist

Student: ____________________________

Date of Meeting: _____________________

Anticipated Exit Date: _________________

Student Present YES NO

Resource Coordinator/Case Manager Present: YES NO

or representative from other services

Transition Timeline Discussed YES NO

DDA/DDS referral complete YES NO

Eligibility letter available?

DORS/RSA Referral complete YES NO

SSI referral complete YES NO

MA referral complete YES NO

Official Identification card YES NO

Discussion about Med Waiver Services

Provider Visits

Minimum 3 visits

Verification of provider visit

Choice letter

Service Funding Plan

MAPS-MD

Transportation/MetroAccess

Guardianship

Selective Service


48

List of Rating Scales and Inventories

Counseling & Advisory B

1. Enderle-Severson Transition Rating Scale – Third Edition (ESTR-III)

ESTR Publications

www.estr.net

2. Reading-Free Vocational Interest Inventory – Second Edition (R-FVII:2)

Ralph L. Becker, Ph.D.

Counseling & Advisory C

1. Assess for Success – A Practitioner’s Handbook on Transition Assessment

Second Edition

A joint publication Corwin Press and DCDT

2. Functional Assessment Report (FAR)

http://www.estr.net/


49

Personal Goals for Transition

Name:

Date:

Year I Plan to Graduate:

CAREER/VOCATIONAL

In my future, I want to .

This year, I have been learning

.

I want to learn how to .

DAILY LIVING



.


COMMUNITY PARTICIPATION



.



50

RECREATION/LEISURE



.


MONEY MANAGEMENT



.


STRENGTHS

I am good at . This

is one of my strengths.

NEEDS

I need help with . This

is one of my areas of needs.

FAVORITE PART OF SCHOOL DAY

My favorite part of the day is

.


51

Personal Information

My name is .

My date of birth is .

I live with

.

My address is

My phone number is

I like to

.

In school, I want to learn

.

(Signature)


52

Planning for the Future

Personal Profile

Name of Student:______________________________________________

What does he/she like to do? With whom?

Where does he/se like to go? With whom?

What is her/his personality like?


53

Relationship Map

Put your child’s name in the center. Put those people who are closest to him/her in the

near circle. These would be people who spend the most time with her/him. Include

family members, teachers, friends, neighbors, service providers, etc. In the next circle

put people who spend some time with him/her, but not as much as those in the first circle,

etc.

Name of student

Who spends the most time with your child? Family? Friends? Professionals? Do you want to change this?


54

Envision the Future

Where does he/she want to be living? Will he/she need support? What kind?

Where does she/he want to be working? Will he/she need support? What kind?

How will he/she get to work and around the community? Will he/she need support?

What kind?

What does he/she want to do in his/her free time? Will he/she need support? What

kind?

______


55

Who will his/her friends? Will he/she need support? What kind?

______

Are there post-secondary education/learning experiences that he/she wants? Will

he/she need support? What kind?

______

The goal that I will begin planning for is…

Be specific. How will you know when you have reached your goal? When do you

want to have achieved this goal? Will you realistically be able to achieve this goal?

______

______


56

Obstacles

What stands in the way of me meeting my goal? Include such things as lack of:

information, services, time, money, etc.

______

Available Resources to Help Overcome the Obstacles

Physical Resources: What things (money, equipment, etc.) do I have that might be

helpful in working on this goal?

______

People Resources: What might some of these people do to help me work on this

goal? (refer to relationship map)

______

Community Resources: What community groups/organizations (church, civic

groups, clubs) might be helpful?

______

Social Service Resources: What social service agencies (school, vocational

rehabilitation agency, etc.) are available to help with this goal?


57

What adult service providers are available to help with this goal?

What financial supports (SSI, Medicaid waiver, etc.) are available to help with this

goal?

______

Prioritize Your Options and Resources

Which resources look most promising?

Which ones will give you the most results with the least effort?

Which ones should you start with first?

1.

2.

3.

4.

5.

Develop Your Action Plan

What can you immediately begin to work on?

When will you have it done?

Who will help you?


58

What is the desired outcome?

How will you know when you have accomplished it?

What will take more time?

USE THE ATTACHED ACTION PLAN FORM

ACTION PLAN FORM

In order to reach my goals…..

What needs to take place immediately --- within the next month

What needs to place down the roald? – within the next 3-6 months

Immediate Steps Who By When Outcome Evaluation

1.

2.

3.

4.

Down the Road Who By When Outcome Evaluation

1.

2.

3.

4.


59

Preparing for My IEP Meeting

1. Introductions

My teachers are:

My program director is

My transition specialist is

My social worker is

My speech therapist is

My job coach is

2. Future Plans and Interests

I plan to graduate in _________________________.

When I graduate I would like to

.

Things I like to do for fun include:

3. IEP Goals – Things I am Learning in School

I am working at ________________________________. I work on

______________________________________________________.

Career Vocational goals help me learn about

.


60

Daily Living goals help me learn about

.

Social Emotional goals help me learn about

.

Math goals help me learn about

.

Reading goals help me learn about

.

Speech and Language goals help me learn about

.

One of my strengths is

.

I want to learn more about

.


61

Student Letter of Invitation to IEP Meeting

Insert Date

Dear :

My teachers have been helping me learn about my IEP goals and my

transition plan. I learned that my IEP goals are about things I will learn in

school. I also learned that I have a transition plan. It talks about things I can

do at home now that will help me be more independent when I am an adult.

My teachers tell me that there will be a meeting on ___________________

to talk about my progress at school and my new IEP and transition plan. I

especially would like to talk about ________________________________.

I would like you to come to my meeting to talk about my goals and my

future. I hope you will be there.

Sincerely,

_____________________________


62



Student Preferences Update:10/8/05

To be completed by: CEP Staff Frequency & Timeframe: 2 times - At age 14-15 and age 19-20

Name: First, Middle and Last

Age: Check only one.

14-15 years old

19-20 years old

Date Completed:

Completed by:

1. What motivates the student to perform work or complete tasks?

(Check all that apply)

Praise

Money

Time with favorite person or people

Who?

Opportunity to do favorite activity What activity?

Food or drink

A sense of accomplishment

Using skills, talents or interests

Pleasing people

Being with people I like

Other:

Comments:

2. How does the student feel about each of these work conditions?


63

(Check the word that fits best – always, sometimes or never.)

Work Conditions

RA

RE

LY

SO

ME

TIM

ES

US

UA

LL

Y

Working alone

Working in a small group (2-5 people)

Working in a large group (6 or more people)

Indoors

Work Conditions continued

RA

RE

LY

SO

ME

TIM

ES

US

UA

LL

Y

Outdoors

Noisy environment

Quiet environment

Busy environment

Work involving people

Work involving machinery (power tools, heavy machines, etc.)

Work involving equipment (e.g. copy machines, shredder, etc.)

Work that involves ideas or concepts

In casual clothing

In dressy clothing

In a uniform

Doing repetitive tasks

Doing varied tasks

In one place during the workday

Moving around during the workday

Unsupervised for most of the workday

Closely supervised for most of the workday

Using current skills

Using skills that require more training or education

Working with or around men

Working with or around women

3. How does the student feel about each of these work schedules?



64

Work Schedules R

AR

EL

Y

SO

ME

TIM

ES

US

UA

LL

Y

Working days (For example: 7:00 am – 3:00 pm, 8:00 am - 4:00 pm, 9:00 am to 5:00 pm)

Working evenings (For example: 3:00 pm – 11:00 pm, 4:00 pm – 12:00 midnight)

Work Schedules continued

RA

RE

LY

SO

ME

TIM

ES

US

UA

LL

Y

Working nights (For example: 12:00 midnight to 8:00 am)

Working weekends (Saturday and/or Sunday)

Working weekdays (Monday – Friday)

Working overtime (extra hours that originally scheduled)

4. What hobbies or activities does the student enjoy?


Movies

Dance

Video or computer games

Other games (cards, board games, etc.)

Listening to music What kind(s)?

Playing music What instrument(s)?


65

Watching sports What kind(s)?

Playing sports What kind(s)?

Arts and crafts What kind(s)?

Other:

Other:


66

Student Skills and Abilities Update: 11/3/05

To be completed by: Teacher Frequency & Timeframe: 4 times - At ages 5 or 6, age 10, age 15 and age 20

Student

Date of Birth

Date Completed:

Completed By

Completed at age: (Check the age at which the form was completed.)

5 or 6 years old

10 years old

15 years old

20 years old

Sensory Skills And Abilities Refer to the Outreach Diagnostic Evaluation summary to complete this section if needed. Check all that apply (except if “Totally blind” is checked.)

Vision

Totally blind (Do not complete any more of the “vision” section. Go directly to Hearing

section.) Uses vision to complete most tasks Check only one.

Yes With magnification

Without magnification

No

Uses vision efficiently (makes judgments based on visual information quickly)

Yes

No

Requires time to make judgments based on visual information

Yes

No

Can discriminate colors Yes

No

With difficulty


67

Specific factors that impact on functional use of vision: Check all that apply.

Contrast Yes

No

Lighting Low

Medium

High

Print/Symbol Size

Normal

Large

Color (check highly preferred combinations)

Black text on white background

White text on black background

Blue text on yellow background

Yellow text on blue background

Other:

Other factors:

Uses glasses Yes

No

Level of assistance needed to use vision accommodations (Refer to the combined Delphi/MSDE scoring system.) Check only one.

Full Physical Prompt

Partial Physical Prompt

Modeling Prompt

Verbal Prompt

Gesture Prompt

Independent

Describe specifics (e.g. help student retrieve from backpack and put on.)

Uses monocular Yes

No




Modeling Prompt

Verbal Prompt

Gesture Prompt

Independent



68

Uses magnifier Yes

No




Modeling Prompt

Verbal Prompt

Gesture Prompt

Independent


Uses colored lenses

Yes

No




Modeling Prompt

Verbal Prompt

Gesture Prompt

Independent


Hearing

Totally deaf (Do not complete any more of the “hearing” section. Go directly to Touch section.)

Can hear normal conversational voices

Yes

No

Uses hearing aid in one ear

Yes Left ear

Right ear

No

Level of assistance needed to use hearing aid (Refer to the combined Delphi/MSDE scoring system.) Check only one.



Modeling Prompt

Verbal Prompt

Gesture Prompt

Independent


Uses hearing aid in both ears

Yes

No


69

Level of assistance needed to use hearing aids (Refer to the combined Delphi/MSDE scoring system.) Check only one.



Modeling Prompt

Verbal Prompt

Gesture Prompt

Independent


Sensitivity to sounds Check all that apply. Add others as needed.

Yes. Please list:

Fire alarm

Air conditioning

No

Touch

Can feel differences in textures Yes

No

Can feel differences in temperature Yes

No

Tolerates being touched Yes

No

Sensitivities to touch (e.g. tap on shoulder, hand on arm)

Yes Please list.

No

Taste and Smell

Has sensitivity to certain smells

List:

Has sensitivity to certain tastes

List:


70

Communication Skills And Abilities Check all that apply in the following sections if the student uses multiple types of expressive language. (For example: Student uses a few signs, some vocalizations and words, and a communication device when it’s available.) Use Speech and Language Therapist or other evaluations or assessments to complete this section if needed. EXPRESSIVE LANGUAGE Non-Oral Expression

Uses facial expressions and/or body language. (e.g. natural gestures such as

pushing something as to indicate refusing or lifting up cup to indicate “drink”.) If checked, please describe below.

Describe facial expression and/or body language used

Explain what student is expressing

Uses sign language Check only one.

Basic Level

Intermediate Level

Advanced Level

Tactual

Oral Expression

Uses oral expression.

Oral communication primarily consists of: Check all that apply.

Vocalizations Please list below

Words Please list below

Phrases Please list below

Sentences

Conversation Describe vocalization, word or phrase Used Explain what student is expressing


71

Augmentative Communication

Uses Voice Output Device Type/Brand Name:

With picture symbols

With textures

With object symbols

With parts of object symbols

With overlays

Uses low technology communication device

Choice Board

Communication Board

With picture symbols

With textures

With object symbols

With parts of object symbols

With overlays

RECEPTIVE LANGUAGE

Receptive language primarily consists of: Check all that apply.

Words

Phrases

Sentences

Conversation

Receptive language modalities used: Check all that apply.

Speech

Sign language

Objects

Picture symbols List consistent words, phrases, objects or

picture symbols understood by student What it conveys to student


72

Communication Strategies

Assist student to effectively communicate by: Check all that apply.

Allowing student time to process

Speaking slowly

Other:

Other:


73

Cognitive Skills And Abilities Attention

Can usually attend to task independently

Maximum # of minutes:

Maximum # of hours:

Attending to task is variable List barriers to attending task

Requires assistance to attend to tasks (Refer to the combined Delphi/MSDE scoring system.) Check only one.



Modeling Prompt

Verbal Prompt

Gesture Prompt

Judgment and Problem Solving

Problem solving abilities Check all that apply.

Can solve simple problems independently

Can solves complex problems independently

Sometimes needs assistance to solve problems

Always needs assistance to solve problems

Types of Problems Assistance needed


74

Memory

Immediate recall (within one hour) Check only one.

Good

Fair

Poor

Short-term memory (within one week) Check only one.

Good

Fair

Poor

Long-term memory (after one week) Check only one.

Good

Fair

Poor

Sequencing

Able to follow 1 step independently Yes

No Note level of assistance needed

Level of assistance needed to follow 1 step (Refer to the combined Delphi/MSDE scoring system.) Check only one.



Modeling Prompt

Verbal Prompt

Gesture Prompt

Able to follow 2 steps independently Yes


Level of assistance needed to follow 2 steps (Refer to the combined Delphi/MSDE scoring system.) Check only one.



Modeling Prompt

Verbal Prompt

Gesture Prompt

Able to follow 3 or more steps independently

Yes Maximum # of steps can follow:


Level of assistance needed to follow 3 or more steps (Refer to the combined Delphi/MSDE scoring system.) Check only one.



Modeling Prompt

Verbal Prompt

Gesture Prompt

Time Awareness

Can tell time Yes Check all that apply:

Analog clock

Digital clock

Talking clock

Braille clock


75

No


76

Understands lapse time Yes Check all that apply:

5 minutes

15 minutes

30 minutes

1 hour

More than 1 hour

No

Scheduling/Planning

Independently schedules and keeps appointments

Yes

No

Can problem-solve scheduling conflicts

Yes

No

Independently follows familiar routine Yes

No

Functional Reading Skills And Abilities

Non-reader. (Do not complete the rest of the reading section. Go directly to Writing section.)

Able to read: Check all that apply.

Print Print size needed:

Braille

Braille Use: Check only one.

Non-contracted

Contracted

Nemeth

Functional - reads select Braille

Reading Grade Level (approximate):

Check all the following functional reading skills the student possesses:

Survival words (e.g. words and signs commonly found in the environment such as “exit”,

“men”, “women”, “help”, etc.) Recognizes own name

Read and understand a work schedule

Read and understand a time sheet

Read and understand simple work instructions

Recognizes own name by symbol

Uses pictures or symbols

Other:

Primary learning media Check only one.

Braille

Auditory

Print

Other:

Secondary learning media Check only one.

Braille

Auditory


77

Print

Other:

Functional Writing Skills And Abilities

Non-writer. (Do not complete the rest of the writing section. Go directly to Functional Math section.)

Uses Braille No

Yes Check all options student can use:

Mountbatton

Braille and Speak

Notetaker

Unibrailler

Slate and Stylus

Other:

Uses other writing accommodations:

No

Yes Check all that apply:

Felt marker

Dictation

Computer

Other:

Can produce own name

Yes Check all that apply.

Writes signature Independent

With assistance

Uses signature guide Independent

With assistance

Uses stamp Independent

With assistance

No

Writing is legible Yes

No

Functional Math Skills And Abilities

Can sort by: Check all that apply.

Texture

Configuration

Shape

Color

Size

Other:

Understands 1 to 1 correspondence Yes

No

Uses the math concepts and operations of: Check all that apply.

Addition

Subtraction

Multiplication

Division


78

Can make purchases independently Yes

No


79

Level of assistance needed to make purchases (Refer to the combined Delphi/MSDE scoring system.) Check only one.



Modeling Prompt

Verbal Prompt

Gesture Prompt

Knows money has value Yes

No

Social Skills And Abilities

Select the response that best represents the student’s skills in each area.

RA

RE

LY

SO

ME

TIM

ES

US

UA

LL

Y

Conversation

Faces people when speaking

Initiates greeting people

Responds appropriately when greeted

Select the response that best represents the student’s skills in each area.

RA

RE

LY

SO

ME

TIM

ES

US

UA

LL

Y

Listens when others are talking

Stays on topic of conversation

Able to start a conversation when appropriate

Able to end a conversation when appropriate

Talks about appropriate subjects

Does not interrupt inappropriately

Shows interest in other people‘s conversation

Manners

Demonstrates social graces appropriate to the situation (Says “thank you”, “excuse me”, ”please”, etc.)

Understands impact of behavior on others (Speaking or laughing loudly, making faces, etc.)

Demonstrates attitudes appropriate to situation (Shows sorrow or sympathy, enthusiasm, respect, etc.)

Interactions

Interacts appropriately with peers


80

Interacts appropriately with males

Interacts appropriately with females

Interacts appropriately with adults

Interacts appropriately with children

Interacts appropriately with authority figures (supervisor, law enforcement, teachers, etc.)

Work Etiquette

Understands chain of command

Understand implications of sexual harassment

Dresses appropriately for work setting and tasks

Grooming and hygiene is appropriate to work setting and tasks

Arrives to work on time

Leaves work at appropriate time

Knows appropriate behavior for break times

Understands conversation appropriate for supervisor

Understands conversation appropriate for co-workers

Physical Skills And Abilities Mobility

Walks with orthopedic canes Yes

No

Uses walker Yes

No

Uses wheelchair Yes Manual

Power

Scooter

No

Can walk short distances (within a home or office setting)

Yes

No

Can walk long distances (over 300 feet) Yes

No

Has functional pace indoors Yes

No

Has functional pace outdoors Yes

No

Can carry objects when mobile Yes

No

Typical gait Steady

Unsteady

Has functional balance in crowded situations

Yes

No

Has functional balance in un- crowded situations

Yes

No


81

Endurance and Stamina

Can perform simple or un-demanding tasks for at least:

Maximum number of minutes:

Maximum number of hours:

Can perform complex or demanding tasks for at least:

Maximum number of minutes:


Can stand at least: Maximum number of minutes:


Can sit at least: Maximum number of minutes:


Reaching

Can reach objects that are at arm‘s length: Check all that apply.

Above waist level

At waist level

Below waist level

Cannot reach out for objects without assistance

Fine Motor, Dexterity and Range of Motion

Hand preference Right

Left

Left hand Check only one.

Full use

Limited use

No use

Right hand Check only one.

Full use

Limited use

No use

Left leg Check only one.

Full use

Limited use

No use

Right leg Check only one.

Full use

Limited use

No use

Head and neck Check only one.

Full range of motion

Limited range of motion

No range of motion

Palmer Yes

No

Pincer grasp Yes

No

Can transfer objects Yes Hand to hand

Container to container

Other:

Other:

No


82

Travel Skills And Abilities

Type of traveler: Visual

White cane

Day only use

Night only use

Day & night use

Use in new environments only

Use for identification purposes only

Can travel INSIDE BUILDINGS on MSB campus:

Independently

With assistance

Describe assistance needed:

Can travel OUTSIDE on MSB campus:

Independently

With assistance


To learn new routes, student requires: Check only one.

Explanation without practice

Minimal instruction (less than 1 month)

Moderate instruction (1-3 months)

Extensive instruction (more than 3

months) Describe details if needed:

Travel supports student requires:

No supervision

Review of travel plan or area

Visual contact (e.g. can watch from within

approximately 5 feet)

Direct supervision (e.g. must watch

within approximately 1 foot)

Verbal prompting

Describe details if needed:

Can cross streets: Check all that apply.

In residential areas

With moving parallel traffic; semi-busy crossing

At lighted intersections

Uses bus: Independently

With assistance



83

Uses taxi: Independently

With assistance


Uses subway/metro: Independently

With assistance


Orientation Skills And Abilities

Can orient self to indoor environments: Check only one.

With no assistance

With minimal assistance (1 month or

less) With moderate assistance (1-3

months) With extensive assistance (3 or more

months) Can acclimate to new table task work environment: Check only one.

With no assistance




months) Can acclimate to new room work environment: Check only one.

With no assistance




months) Can acclimate to new building environment: Check only one.

With no assistance




months) Can work left to right Yes

No

If no, why?


84

Can work top to bottom Yes

No

If no, why?

Can move to next tasks or activities: Check only one.

With no assistance


less)

With moderate assistance (1-3 months)

With extensive assistance (3 or more

months)

Knowledge of distances:

No understanding of distances

Knows approximately 3 feet (arms

length)

Knows approximately 10 feet or more


Understands body size (height, weight) in relation to surroundings (e.g. understands if there is sufficient room to move between objects, past a person in a doorway, underneath a doorway, etc.)

Yes

No


Office Equipment Skills And Abilities Check all that apply. Check only if student has sound basic knowledge of most common types of equipment listed that would assist them in immediately, or quickly, using an unfamiliar machine. Check all equipment student can use AND details regarding knowledge and experience with that equipment.

Computer List Details Below (e.g. Used for 1 year daily at job.)

Text to speech software (e.g. JAWS)

Other:

List Accommodations Used

Text to speech software (e.g. JAWS)

Other:


85

Calculator List Details Below (e.g. Used for 1 year daily at job.)

List Accommodations Used Below

Abacus List Details Below (e.g. Used for 1 year daily at job.)


Telephone List Details Below (e.g. Used for 1 year daily at job.)


Large button phone

Other:

Calculator List Details Below (e.g. Used for 1 year daily at job.)


Copy machine List Details Below (e.g. Used for 1 year daily at job.)


Paper shredder List Details Below (e.g. Used for 1 year daily at job.)


Postage machine List Details Below (e.g. Used for 1 year daily at job.)



86

Fax machine List Details Below (e.g. Used for 1 year daily at job.)


Other: List Details Below (e.g. Used for 1 year daily at job.)


Advocacy Skills And Abilities

Recognizes authority figures in workplace

Independently

With assistance

Describe:

Asks for help appropriately Independently

With assistance

Describe:

Identifies and states needs appropriately

Independently

With assistance

Describe:

Identifies and states wants appropriately

Independently

With assistance

Describe:

Knows personal strengths and weaknesses

Yes

No

If no, describe:


87

Can verbalize basic personal information when needed (e.g. State name, telephone number, address, emergency contact)

Yes

No

Describe:

Can produce basic personal information when needed (e.g. Show paper with name, telephone number, address, emergency contact)

Yes

No

Describe:

Requests additional work or tasks Independently

With assistance

Describe:

Safety Skills And Abilities

Knows basic first aid Yes

No

Recognizes cautionary signs (e.g. “wet floor, “danger”, “out of order”)

Yes

No

Recognizes emergency situations (e.g. fire/smoke, injury/illness, danger)

Yes

No

Can respond to emergency situations Yes Check all that apply.

Can call 911

Can get appropriate person to help

Can call out for help

Can leave danger area

No

Can protect self (e.g. keep personal information to self, know who to go with, who to open door to, leave dangerous situation, etc.)

Yes

No

Can protect personal property (e.g. purse/wallet, purchases, keep money hidden, etc.)

Yes

No

Knows safety issues specific to job/work environment

Yes

No


88

Combined Delphi/MSDE Scoring System Periodically in the Staff Skills and Abilities form, the level of assistance needed by a student needs to be documented. The following are the official Maryland School for the Blind categories and definitions for these levels of assistance. (The previous version included additional levels that are no longer in use (and have been incorporated into one of the following six levels. )

PROMPT LEVEL DEFINITION


Requires staff to place his/her hand over or under the student‘s hand and move it toward the response desired.


Requires staff to touch the student to elicit desired response.

Modeling Prompt

Requires staff to imitate the desired response with the student imitating the staff‘s model.

Verbal Prompt

Requires staff to give a specific verbal direction in addition to the task direction. Given a task direction, the student is unable to perform correctly until another (more specific) verbal prompt is provided. A signed prompt is the equivalent of a verbal prompt for a student who is deaf/blind.

Gesture Prompt

Requires the staff to move is/her finger, hand or arm OR make a facial expression that communicates to the student specific information to elicit the desired response.

Independent

No staff intervention of any type is needed for the student to perform the task. The student is able to generalize task performance across all settings.


89

SUMMARY OF SELF-AWARENESS INVENTORIES CAREER EDUCATION

The Maryland School for the Blind

STUDENT’S NAME:

Compiled by: Date Compiled:

SELF-ASSESSMENT INVENTORIES COMPLETED FROM: The Janus Job

Planner Series….

1. Interest Inventory

2. Working Conditions Inventory

3. Working Experience Inventory

4. Work Attitude Inventory

5. Self-Esteem, Confidence & Personality Inventory

6. Values Inventory

FINDINGS: All inventories are orally dictated and read to the student and the student’s

verbal responses are recorded by the evaluator. The following are the individual’s

inventory results.

1. Interest Inventory Results: The results are ranked according to the individual’s

priority preference.

Number 1 = highest preference and Number 8 = least preferred

RANKING WORK AREA/WORK PREFERENCE POINT SCORE

1 CLERICAL JOBS

2 SALES JOBS

3 SERVICE JOBS

4 PHYSICAL JOBS

5 DRIVING & OPERATING JOBS

6 MECHANICAL & REPAIRING JOBS

7 CARING & HELPING JOBS

8 CREATIVE JOBS

Evaluator:

Date Completed:

2. Work Conditions Inventory Results: The checked items indicate the student’s

preference.


90

Evaluator: Date Completed:

_____ Work Indoors _____ Work Outdoors

_____ Work Alone _____ Work with Others

_____ Work with People _____ Work with Things

_____ Moving Around _____ Sitting Still

_____ Busy Place _____ Quiet Please

_____ Wear a Uniform _____ Wear Dressy Clothes

_____ Do the Same Task _____ Do Different Tasks

_____ Perform Unskilled Work _____ Perform Semi-Skilled Work

_____ Be Supervised _____ Not be Supervised

_____ Stay in Place _____ Travel Around

_____ Work with Ideas _____ Wear Casual Clothes

_____ Perform Skilled Work


91

Things that are Important to Me Very

Important

Somewhat

Important

Not

Important

Personal Care

Getting dressed by myself 1 2 3

Taking care of my personal hygiene 1 2 3

Cutting my food when I eat 1 2 3

Making my own lunch or breakfast 1 2 3

Daily Living

Making my own bed 1 2 3

Learning to shop for groceries 1 2 3

Learning to cook 1 2 3

Helping my family with chores 1 2 3

Learning to use public transportation 1 2 3

Recreation/Leisure

Learning to get along with friends 1 2 3

Making new friends 1 2 3

Learning new games or hobbies 1 2 3

Visiting friends when I am not in school 1 2 3

Schoolwork

Reading 1 2 3

Math/using money 1 2 3

Computer 1 2 3

In-school job 1 2 3

Writing 1 2 3

Community Trips 1 2 3


92

Other:

______


93

Transition Interview Questions

Current Grade □ Repeat? □ Student‘s Name: Birthdate: Age: Date:

Interview conducted by:

Current address/telephone #: Counselor:

Student‘s Case Manager: School:

Interests

1

What are your hobbies or interests? What do you like to do in your free time?

2

What activities do you participate in?

3

What is your proudest accomplishment?

4

What do you like best about yourself?

5

Is there anything you would like to improve or change about yourself?

6

How do you get around now? What type of transportation do you use?


94

School Based Information

7

What classes have you liked taking in school? Why?

8

What classes have you NOT liked taking in school? Why?

9 What classes would you like to take?

10 What do you do well?

11 What part of learning is hard for you? (Why do you have an I.E.P.?)

12

What will be your high school completer? 2 credits of a foreign language 2 credits of advanced technology 4 credits of a career/tech program

13

How do you learn best? Listening to directions Reading directions by yourself Watching someone demonstrate

14

Have you heard about the programs at the Thomas Edison High School of Technology? Are there any programs that interest you?


95

Work Experience

15

Have you ever had a job where you have been paid?

16

Have you had a volunteer or unpaid work experience?

17

Have you started earning/earned SSL hours? If so, what have you done to earn them?

18

What jobs or careers have you thought about for yourself?

Future Plans

19

What do you plan on doing after high school? (employment, training, college, military)

20

Are you planning on going to college? Do you have any particular colleges in mind?

□ 2-year

□ 4-year

21

What do you consider important about the future?

22

Where do you see yourself living after you exit high school?

Student Signature

Date


96

SURVEY OF INDOOR AND OUTDOOR RECREATIONAL ACTIVITIES

Student’s Name

Date

Person Completing the Form

Directions: Place a “ ” next to the activity that you would like to participate in.

Place an “o” next to the activities that you have already participated in.

Structured Indoor Activities (done by yourself)

_____ Computer games

_____ Video games

_____ Completing a puzzle

_____ Make a photo album

_____ Organizing something

_____ Listening to a talking book

_____ Reading a book/magazine/newspaper

_____ Completing a model airplane or similar project

_____ Arts and crafts

_____ Playing a specific song on a musical instrument

_____ Following a cooking recipe

_____ Sewing

_____ Take a class for fun

_____ Other


97

Unstructured Indoor Activity (done by yourself)

_____ Solitary card games

_____ Painting/drawing/doodling

_____ Arts and crafts

_____ Listening to music

_____ Playing a musical instrument

_____ Watching a television show or movie

_____ Writing an email or letter

_____ Exercising indoors

_____ Polishing fingernails/putting on makeup

_____ Arranging flowers

_____ Go shopping alone

_____ Play games at an arcade

_____ Other

Unstructured Team/Group Outdoor Activities

_____ Fishing with a group

_____ Bird watching

_____ Group car drive

_____ Barbecuing/cooking outdoors

_____ Go on a picnic

_____ Attend a fair

_____ Go to the park with others

_____ Horseback riding

_____ Go to amusement park


98

_____ Other

1. Tally up the number of indoor and outdoor activities checked that you

have an interest in trying:

Indoor_______________________

Outdoor_____________________

2. Were more indoor or outdoor activities checked off?

3. Were more activities done alone or group activities checked off?


99

FAMLY INTERVIEW FORM

Student Name: Age/DOB:

Interviewer:

FAMLY INFORMATION

Name of Parent/Guardian:

Address:

Daytime Phone: Evening Phone:

Siblings Names:

Do siblings live with student? Other family members?

Applied for benefits? Y N Benefits Received:

Do you provide private services at home for your child? Y N

(confidential)

If yes, what services?

MEDICAL & EMERGENCY INFORMATION

Physician’s Name: Phone:

Insurance Information:

What medication(s) does your child take regularly?

Do these medications have any side effects that could affect their performance?

Does your child have any allergies? Y N If yes, please list them and treatment

needed:

Does your child have seizures? Y N If yes, how often?

Is there a protocol for recovery? (Describe):


100

PREFERENCES FOR THE FUTURE

What would you most like your child to be doing after graduation?

Work:

Postsecondary:

Living Situation:

Social/Leisure:

Transportation:

Finances:

What do you think your child would most like to be doing after graduation?

Work:

Postsecondary:

Living Situation:

Social/Leisure:

Transportation:

Finances:

What is your vision for your child at age 30?

______

What do you see as your child’s greatest challenges? What are your fears for the

future?

What would like more information and/or training about?

Would you like information on how to apply for financial support for your child?

Y N


101

COMMUNICATION

How does your child communicate best with others?

How does your child indicate a need?

How does your child express emotions?

How does your child indicate a preference or make a choice at home?

How does your child indicate a non-preference or “No”?

What kind of instructions can your child follow?

Does your child initiate communication? Y N How?

Does your child sustain communication? Y N

Does your child ask for help? Y N How?

Does your child use and understand manual signs? Y N Not applicable

Does your child use and understand PCS symbols? Y N Not applicable

Has your child ever used an assistive device to communicate? Y N If yes, name

of device/method?

Would you like to explore assistive/alternative communication methods? Y N

What devices/methods would you like information about?

BEHAVIOR SUPPORT

Does your child have challenging behaviors? (If yes, please describe):

When do these behaviors happen most?

Why do you think they happen?

Does your child have a Behavior Intervention Plan? Y N

Which intervention(s) were most effective?

Which intervention(s) was least effective?


102

TRANSPORTATION

How does your child get to/from school?

How does your child get to activities/places after school and on weekends?

Does your child have a public transportation pass for individuals with disabilities?

Y N

Would you like your child to get one? Y N

Would you like information about public transportation for people with disabilities?

Y N

Who could transport your child to/from a jobsite in an emergency?

Student Action Yes- Alone Yes – with help No Priority?

Rides school bus

Rides public bus

Rides subway

Rides taxi

Rides paratransit system

Reads bus schedule

Reads subway map

Pays driver correct fare

Crosses street safely

HOUSEKEEPING

Does your family clean or do you use a cleaning service?

What cleaning products does your family use at home?

Bathroom: Kitchen:

Living Room: Dining Room: ______

Bedroom: Other:

Does your child receive an allowance? Y N Other Incentive:


103

Student Action Yes-

alone

Yes-with

help

Assists

Others

No Like/Dislike Priority?

Kitchen

Dishes- machine sink

Sweeps floor

Mops floor

Wipes countertops & table

Wipes stovetop &

microwave

Takes out garbage

Bedroom

Makes bed

Straightens room

Vacuums

Does laundry

Bathroom

Scrubs toilet

Vacuums/sweeps floor

Mops floor

Cleans shower

Cleans mirror

Wipes countertop

Living Room & Dining Room

Dusts – large small

both

Vacuums

Polishes furniture

Outdoors

Rakes leaves

Mows lawn

Care for plants/lawn

Sweeps porch/balcony


104

FOOD PREPARATION AND EATING (HOME)

What foods does your child prefer?

______

What foods does your child especially dislike?

Beverages likes/dislikes?

Dietary needs/restrictions/food allergies?

What table manners or eating behaviors are priorities?

Does your family eat together? Y N If yes, what meals?

What appliances do you use at home? ____Dishwasher ____Microwave

____Toaster____Toaster Oven ____Blender ____Gas Stove ____Electric Stove

____Coffee Maker____Other (list):

Student Action Yes-alone Yes-with help No Like/Dislike Priority?

Food Preparation

Indicates food

preference

Prepares snack

Prepares single meal

Assists making large

meal

Uses stovetop

Uses oven

Uses microwave

Sets table

Moves hot food

carefully


105

Eating

Uses utensils

Uses napkin

Chews/swallows before

taking more food

Passes/receives food

Cleanup

Removes dishes/napkin

Places dishes in sink

Clears table of all

dishes

Washes/dries dishes –

puts in dishwasher

Stores leftovers

Puts dishes away

Empties dishwasher

COMMUNITY LIFE

Please list what establishments your family visits most, and student’s preferred

places:

Grocery store: Pharmacy:

Convenience store: Library:

Post office: Church/temple:

Bank: Hair Salon/Barber:

Video store: Park:

Shopping mall: Other:

Does your child take vacations? Y N Where?

Does your child carry a wallet/purse? Y N Does your child have an ID card?

Y N

Would you like your child to have an ID card? Y N

What clubs/organizations does your child participate/belong?


106

Student Action Yes-

alone

Yes-with

help

Assists

Others

No Like/Dislike Priority?

Indicates preferred activity

Locates bathroom

Uses bathroom

Selects items to purchase

Asks for help if needed

Locates end of line

Waits in line

Budgets money for needed

items

Chooses items within

spending limit

Pays for items

Shops for groceries

Mails items

Emails/responds to emails

Shops for clothing

Selects/checks out books

and movies

Purchases movie

tickets/snacks

Locates stores in mall

Uses cell phone

Uses elevator/escalator

Uses appropriate behavior

in public

Locates information on the

Internet

Uses ATM/debit card


107

SELF-MANAGEMENT

Student Action Yes-alone Yes-with help No Needs full

assistance

Priority?

Bathroom

Showers

Bathes

Brushes teeth

Uses mouthwash

Washes face

Cares for fingernails

Blows/wipes nose

Uses toilet

Brushes hair

Uses deodorant

Uses cologne/perfume

Applies makeup

Uses blow dryer

Bedroom

Chooses clothing

Dresses in pullover

shirt

Dresses n shirt with

adapted closure

Dresses in button-down

shirt

Dresses in pants with

button/zipper

Dresses in pants with

adapted closures

Places socks on feet

Places shoes on feet

Ties shoes

Uses adapted shoelaces


108

Student Action Yes-alone Yes-with help No Needs full

assistance

Priority?

Dresses in bra

Dresses in underwear

Personal

Has had sexual

education

Understands

precautions to take

during intimate

relations

Takes care of menstrual

needs

SOCIAL AND RECREATION SKILLS

Does your child indicate preferences? Y N Does your child initiate

activities? Y N

Does your child sustain participation in activities? Y N For how long?

Activity Enjoys? Regular Location Priority?

Shopping

Going to movies

Watching DVDs

Playing board games

Watching TV

Playing cards

Going to sports events

Playing sports

Exercising in gym

Reading magazines

Using the Internet/email

Playing computer games

Playing video games

Listening to music


109

Activity Enjoys? Regular Location Priority?

Going to park/being outdoors

Hanging out with friends

Going to amusement park

Reading a book

Going to concerts/plays

Talking on the phone

Texting friends

Other:

Who are your child’s friends?

Does your child visit friends/relatives?

Does your child date? Y N Does he/she want to date? Y N

Would you like your child to learn appropriate interactions and behavior for

dating? Y N


Interaction different with family, friends,

strangers

Initiates interaction

Sustains interaction

Ends interaction

Age-appropriate interaction

Greets/says goodbye to others

HEALTH AND SAFETY


Health

Tells others when sick or injured

Takes medication

Exercises regularly

Avoids illegal substances

Knows the effects of smoking


110


Eats nutritious foods

Understands birth control measures

Uses poisonous or harmful materials

carefully

Safety

Uses caution with strangers

Avoids and reports sexual abuse

Understands difference between

rape/assault and consensual sexual

relationship

Uses dangerous objects carefully

Exits building for a fire alarm/emergency

Recognizes purpose of smoke detector

Will call 911 in an emergency

Reports emergency situations to others

Uses caution with strangers

Uses home telephone

Uses cell phone

Cares for small cuts and wounds

Reads safety signs

MONEY MANAGEMENT


Writes checks

Balances checkbook/account

Fills out deposit slip

Fills out withdrawal slip

Withdraws money at ATM machine

Deposits money at ATM machine

Uses debit card to make purchases

Uses credit card to make purchases


111

Carries wallet or purse

Creates budget for expenses

Follows budget for expenses

Counts out dollars for purchases

Counts out dollars and coins for

purchases

Uses pre-counted money envelopes for

purchases

Pays bills

TIME AND SCHEDULES

Does your child wear a watch? Y N Analog or digital face watch?

Does your child use an alarm clock to wake up? Y N

Does your child use a calendar to plan events? Y N

Does your child know specific events/holidays? Y N

If you child does not wear a watch or use an alarm clock, does he/she use a cell

phone for timekeeping/waking up? Y N If not, how does your child keep a

schedule and how does he/she wake up in morning?


Organizes activities with friends/family

Avoids scheduling two or more activities

for the same day/time

Schedules appointments

Remembers and keeps appointments

Prepares materials in advance for

activities

Arranges transportation for activities in

advance

Submits materials (homework, bill

payments, etc.) by specified date

Tells time with digital watch

Tells time with analog watch/clock

Associates events with specific time

Uses cell phone for clock


112

MATH OPERATIONS


Mentally adds/subtracts

_____1 digit numbers



Adds/subtracts by counting

Uses calculator to complete operations

Completes multiplication/division

problems

Completes algebraic equations

READING

Does your child read at home? Y N

If yes, what does your child read at home?

What topics does your child like to read about?

What topics does your child dislike reading about?

Does your child use a camera? Y N Video camera? Y N


Reads books, newspaper/magazine articles

Looks at pictures in books, newspapers

and magazines

Sounds out new words

Pieces together familiar letter

combinations/words to decipher new

words

Recognizes specific site words

Understands what is read to him/her

Composes sentences in writing

Composes paragraphs/essays in writing


113

Writes single word responses

Dictates self-composed sentences

Dictates self-composed paragraphs/essays

Dictates single word responses

Puts pictures or PCS symbols together to

tell a story

Creates composition with video camera

Identifies numbers 1-10

Identifies numbers 1-100

Can match numbers (ex. – if given a “6”

on a card, could identify “6” button on a

cell phone)

Adapted from Syracuse Community-Referenced Curriculum Guide, 1989; COACH,

1998; Snyder, 1991; RG


114

Functional Life Plan-Staff Questionnaire Parents, please take a few moments to think about your student and answer these

questions.

Describe your student:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

What are YOUR dreams for your student? (list them no matter how big or small they

are):____________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

What are your fears for your student?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

What are your student’s strengths/interests?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

What are your student’s needs/dislikes?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

List at least three things you would like your student to work on during the upcoming

school year:

!.______________________________________________________________________

________________________________________________________________________

2.______________________________________________________________________

________________________________________________________________________

3.______________________________________________________________________

________________________________________________________________________


115

Functional Life Plan Process

Schedule meeting

Each meeting will need a facilitator and a support person

2 weeks prior to meeting send home parent packet

2 weeks before meeting give packet to teachers

Hold meetings – parents and teacher should bring completed packets

Type notes of meeting

Distribute notes to all team members

Identify how conclusions from meeting will be used in goal development


116

(Date)

Dear Parents/Caregivers:

We will be having a “Functional Life Plan” (FLP) for your son/daughter this school year.

In preparation for the meeting, we are asking you to complete the enclosed form. Please

include as much detail as you can. Keep in mind that at the FLP we will be planning for

you son’s/daughter’s future years at school, as well as, post graduation.

There is no “right” or “wrong” answers. Anything that you feel is important for people to

know, please include. Do not be afraid to “dream” about your son’s/daughter’s future,

even if you are not sure about the options after graduation. You will be asked to bring

your survey with you to the meeting.

Also enclosed is a brief description of some of the services post graduation. Please do

not allow the options to limit your thinking when completing the survey.

Within the next couple of weeks you will receive a notice of the scheduled date for your

son’s/daughter’s FLP meeting. Please make every attempt to attend. Also, please invite

family members, close friends, church members…any body that has a relationship with

your son/daughter. The more input we have, the better the plan will flow.

We are looking forward to working with you and your son/daughter in the FLP process.

Should you have any questions, please contact (teacher/transition specialist).

Thank you in advance for your cooperation.

Sincerely,


117

Functional Life Plan

“Let not our needs determine our dreams…..

But let our dreams determine our needs”

Colleen F. Tomke

Keep the focus of your vision on your student’s strengths and interests. Think

about the things in life that you value and would like your student to have. Most

people value their relationships with others and being an active member of society.

We also tend to value being able to pursue things we are good at and using them for

something meaningful and purposeful.


118

Top Ten Practical Tips For Parents

10. Keep a POSITIVE Attitude! Choose Happiness!

9. Invite people into your life – People want to help…they just don’t

know how!

8. Become knowledgeable! Educate yourself! Document everything

and keep copies together.

7. Always focus on your child’s STRENGTHS!

6. Give your child the chance to be “All he or she can be”

5. Dream big and continue to dream! Many people become

successful because of what “others believed they could do!”

4. Take one day at a time – realize the progress you’ve made!

3. Keep making friends! Somewhere along the way you will meet

someone who can help you in your daily work!

2. If you are not happy with the results you are getting, go up the

chain of command.

1. Sometimes we must create our own support system, with our own

family and close friends and also within the community.


119

Functional Life Plan

Student: Age:

Graduation Date:

Attendees:

Functional Vision:

Functional Hearing:

Current Health Status:

“I am good at…/I like doing…”:

“When I graduate from ___________, I would like to live…”

“The most important supports that I need are…”

“During the day, I would like to…”

Self Care Skills:

Dressing

Hygiene

Bathroom

Eating

Snack Prep

Money Management:


120

Time Management:

Mobility:

Communication:

Assistive Technology:

Hobbies/Recreation/Leisure:

Obtaining Employment:

Education/Training:

Personal Safety/Security:

Self-worth (things I do that make me feel good):

Behaviors:

Themes/Priorities:

Questions/Concerns:

To do list:

Maryland School for the Blind


121

PROGRAM FOR TRANSITION

PARENT SURVEY

Student Name:__________________________________ Date of Birth:___________________________________ Proposed Date of Transition:_______________________ VOCATIONAL NEEDS

1. When he/she graduates from school, we would like our child to

participate in the following post-school programs:

______Competitive Full Time Employment ______Supported Employment ______Vocational/Sheltered Employment ______Other:

2 Please choose jobs that your child seems particularly interested in at this time. Mark those jobs with an X. If there are jobs that you feel your child would not work well in or that you would not like to see your child participate in please make those jobs with an O.

______Carpenter ______Food service ______Recycling ______Facilities Maintenance ______Delivery Service ______Laundry duties ______Health club assistant ______Groundskeeping ______Cleaning Service ______Trash Collection ______Landscaping ______Clerical ______Assembly ______Delivery Service

3. Are there any occupations in which you object to your child‘s participation?


122

4. Are there any medical concerns relating to your child‘s vocational placement?

5. Circle all the skills that you need to be developed to help your child reach

his/her Vocational goals:

Self-Help

Work Quantity

Peer Relations

Work Habits and Attitude

Work Quality

Motivation

Relationship with Authority

Transition Skills

Initiative 6. What duties or responsibilities does your child have at home? 7. Following graduation from school, what do you hope that your child‘s living arrangements will be:

At home

Independent apartment (alone, with friends, with spouse?)

Group home

Other (Please specify)__________________________________________

8. What leisure and recreational activities does your child participate in with

family and friends?


123


Student Dream Sheet Last Update: 11/3/05

To be completed by: Student (See note and end of document if student is unable to complete.) Frequency & Timeframe: 2 times – At age 14-15 and again at age 19-20

Your Name:

Date Completed:

Your Age: 14-15 years old

19-20 years old

Completed By:

Relationship to Student:

Student

Family Member

Teacher or Para-educator

Other:

1. I would like to live in the following town or city and county when I graduate: (List more than one town/city or county if desired.)

Town or City: 1st choice: 2nd choice:

County: 1st choice: 2nd choice:

Comments:

2. I would like to live in the following type of housing after I graduate: (Check more than one if desired.)

Apartment

Condominium or Townhouse

House

Comments:

3. I‘d like to live with the following people after I graduate: (Check more than one option if desired.)

Alone

Friend(s)

Roommate(s) (People I don‘t know, or don‘t know well.)


124

Parents

Other Family Member (Brother, sister, cousin, parent, etc.)

Boyfriend/Girlfriend

Husband/Wife

Other:

Comments:

4. I‘d like to continue my education after graduating from MSB:

Yes

No

Not sure

5. (If you checked ―yes‖ on question #4) I‘d like to continue my education

through: (Check all that apply.)

Continuing education courses at public school (Iocal)

WTC

Community College (2-year college)

Trade School

4-year College or University

GED

6. *My dream job would be…

Dream Job What I like about this job is: What interests me about this job is:

1.

2.

3.

7. The kind of employment situation I would like after graduation is:

Part-time (34 hours or less per week)

Full-time (35 hours or more per week)

Volunteer (no compensation for work)

Seasonal (work during part of the year, e.g. summer, spring, etc.)

Other:

8. After I graduate, the amount of money I need, or want, to earn is:

$ (Check only one of the following.) Per month year every two weeks (bi-weekly) week


125

9. After graduation, the amount I‘d like to work each week is…

Number of days per week:

Number of hours per week:

Career Education Program Staff: The order of preference for who completes this form is 1)

The student 2) The student with help from a family member 3) A family member and 3)

An MSB staff person who knows the student well.

*Categorize each of the student‘s dream job responses (from question #6) into one of the following types - taken from the Interest Inventory:

Caring and Helping Jobs

Sales Jobs

Creative Jobs

Service Jobs

Mechanical and Repairing Jobs

Driving and Operating Jobs

Clerical Jobs

Physical Jobs


126

Preferences and Interests

Name:

Date:

Understanding my preferences and my interests is important to help me

make plans for my future. They can help guide me in making my decisions

for work, where I want to live, and how I use my free time.

MY PREFERENCES AND INTERESTS JOB CHOICES

___________________________________ ___________________________

___________________________

___________________________

___________________________________ ___________________________

___________________________

___________________________

___________________________________ ___________________________

___________________________

___________________________

___________________________________ ___________________________

___________________________

___________________________


127

Functional Life Plan-Parent Questionnaire

Parents, please take a few moments to think about your child and answer these questions.

Describe your child: _______________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

What are YOUR dreams for your child? (list them no matter how big or small they are):

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

What are you fears for your child? ___________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

What are you child’s strengths/Interests? ______________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

What are your child’s needs/dislikes? _________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

List at least three things you would like your child to work on during the upcoming

school year:

1. __________________________________________________________________

__________________________________________________________________

2. __________________________________________________________________

__________________________________________________________________

3. __________________________________________________________________

__________________________________________________________________


128

Transition Services-Parent/Guardian Questionnaire

Employment After graduation from school, I would like to see my son/daughter working:

_____ Full time or part time in the community without any support working

in the area of ____________________________________________

_____ Full time or part time in the community with support from a job coach

working in the area of _____________________________________

_____Working in a sheltered or center-based program

_____ I do not expect my son/daughter to work

_____ I am not sure at this time

Paid employment is an important consideration for long-term employment goals

_____YES _____NO

Have there been opportunities for part time employment (paid or volunteer)? _______

Additional Comments: _____________________________________________________

________________________________________________________________________

________________________________________________________________________

Education After graduation from school, my education goals for my son/daughter are:

_____ Attend a college program with emphasis on life skills curriculum

_____ Vocational training to specific to long-term employment goals

_____ Participation in adult education classes

_____ I am not sure at this time

_____ I am not planning for my son/daughter to participate in further education


________________________________________________________________________

________________________________________________________________________

Adult living Where do you envision your son/daughter living as an adult?

________________________________________________________________________

________________________________________________________________________

Does you son/daughter currently have regular chores or household responsibilities?

________________________________________________________________________

________________________________________________________________________

Does you son/daughter assist with meal planning and preparation? __________________


129

How much supervision does you son/daughter need?

_____ Continual, 24 hour supervision

_____ Close supervision-can be alone in another room with an adult in the house

_____ Can be home alone for brief periods of time

_____ Can be home alone for extended periods of time, with an adult home

overnight

_____ Can be left alone overnight

What do you feel is the most important area to address in order to achieve greater levels

of independence as an adult? ________________________________________________

________________________________________________________________________

________________________________________________________________________


________________________________________________________________________

________________________________________________________________________

Independent Living What areas of self-help/personal hygiene are of most concern to you at this time?

________________________________________________________________________

________________________________________________________________________

Does your son/daughter receive an allowance? _________

Does he/she use a wallet? _________

Are there opportunities for making purchases in the community? ___________________

________________________________________________________________________

Does he/she use a bank account? __________

Do you feel you son/daughter is able to speak up for himself/herself or make needs

known? __________


________________________________________________________________________

________________________________________________________________________

Community Participation and Recreation/Leisure Does you son/daughter have special friends? __________

Does he/she need assistance to make leisure plans? __________

Does he/she use the telephone independently? __________

What does he/she do for fun? ________________________________________________

________________________________________________________________________

Are there community recreational opportunities with peers? _____ How often? _____

How do you anticipate he/she will travel within the community as an adult?

_____Walk _____Metro _____Bus _____Car/Cab

Do you think he/she will obtain a driver’s license? __________


________________________________________________________________________


130

Future planning Does you son/daughter have an understanding of his/her disability and how it impacts

their day-to-day abilities?

After graduation, what do you believe will be your son/daughter’s primary means of

income or financial support?

_____SSI/Social Security

_____Own wages

_____Your support

_____Not sure at this time

Have you submitted applications to DDA (Maryland residents), DDS (DC residents),

CSB (Virginia residents) for adult support services __________

Does your son/daughter receive SSI? __________

Does your son/daughter receive Medical Assistance? __________

Have you considered issues related to guardianship when your son/daughter turns

18? __________

Have you obtained legal guardianship (for students 18 years and older)?

Do you need any additional information regarding the above mentioned services?

________________________________________________________________________

________________________________________________________________________


________________________________________________________________________

________________________________________________________________________

Student Name: _______________________________________________________

Parent Signature: _____________________________________________________

Date: _______________________________________________________________

Thank you for providing your opinions and ideas. The valuable information you have

shared will be useful as we work together as a team to assist your son/daughter to

achieve future goals and dreams.


131

COURSE OF STUDY PLAN Date of Plan:_____________________________ Student Name:______________________________________________ DOB:________________________________________ COURSE OF STUDY Activities of daily living Job Sampling & Employment Training Supported employment

Potential employment

Employment training

Education

Independent Living PROJECTED EXIT DATE: ___________________________


132

FUNCTIONAL CAREER DEVELOPMENT PORTFOLIO

Student Name:___________________________________ DOB:__________________________ My Functional Career Development Portfolio was officially begun on this date: Date:__________________________ Grade:________________________ Student Signature:____________________________________________________ Staff Signature:_______________________________________________________


133

PROGRAM FOR TRANSITION-PARENT SURVEY

Student Name:__________________________________ Date of Birth:___________________________________ Proposed Date of Transition:_______________________ VOCATIONAL NEEDS

2. When he/she graduates from school, we would like our child to

participate in the following post-school programs:

______Competitive Full Time Employment ______Supported Employment ______Vocational/Sheltered Employment ______Other:

3 Please choose jobs that your child seems particularly interested in at this time. Mark those jobs with an X. If there are jobs that you feel your child would not work well in or that you would not like to see your child participate in please make those jobs with an O.

______Carpenter ______Food service ______Recycling ______Facilities Maintenance ______Delivery Service ______Laundry duties ______Health club assistant ______Groundskeeping ______Cleaning Service ______Trash Collection ______Landscaping ______Clerical ______Assembly ______Delivery Service

9. Are there any occupations in which you object to your child‘s participation?


134

10. Are there any medical concerns relating to your child‘s vocational placement?

11. Circle all the skills that you need to be developed to help your child reach

his/her Vocational goals:

Self-Help

Work Quantity

Peer Relations

Work Habits and Attitude

Work Quality

Motivation

Relationship with Authority

Transition Skills

Initiative 12. What duties or responsibilities does your child have at home? 13. Following graduation from school, what do you hope that your child‘s

living arrangements will be:

At home

Independent apartment (alone, with friends, with spouse?)

Group home

Other (Please specify)__________________________________________

14. What leisure and recreational activities does your child participate in with

family and friends?


135

Career Cluster Collage

Group Project

Purpose: Students should be in groups of 3-4 students. Each group will be

responsible for creating a collage and presentation for one Career Cluster.

Supplies: 1 Piece of Poster Board for each student, various magazines to cut

pictures out of, newspapers, scissors, glue sticks, markers.

Project Directions

Speaker –

Assist group members in developing research for the speech and help

cut and paste the collage

Prepare the speech on Career Cluster Collage

Give the speech to the class

Researcher(s) –

Use the Career Cluster booklet to gather information for the speaker

Research topics should include

Introduction of the Career Clusters

Characteristics of workers in this career path

Examples of jobs found in this Career Cluster

Elective courses recommended for this career path

Activities to be involved in

Want ads from the local newspaper that fit the Career Cluster

Collage Workers –

Cut letters or use letter guide and pens for the title of your Career

Cluster

Cut out pictures that represent jobs found in your Career Cluster

Glue/paste pictures onto paper

Label pictures with the “job title”

Tape collage on board on day of presentation

****Note: All group members must be in front of the class during the presentation.


136

CAREER CLUSTER DESCRIPTIONS

ARTS, MEDIA & COMMUNICATION SUBTITLE: FUNCTIONAL COMMUNICATION SKILLS Students interested in this cluster are preparing for functional life skill activities that include all methods of communication available to increase the quality of daily living, independent living, vocational, and peer interaction. BUSINESS MANAGEMENT & FINANCE SUBTITLE: PURCHASING SKILLS Students interested in this cluster are preparing for basic money handling including accurate counting and purchasing of required items in order to function in daily living. CONSTRUCTION & DEVELOPMENT SUBTITLE: FACILITIES MANAGEMENT SKILLS Students interested in this cluster are preparing to work on site with facilities to ensure that cleanliness and order are available for the working public. CONSUMER SERVICE, HOSPITALITY & TOURISM SUBTITLE: RETAIL SKILLS Students interested in this cluster are preparing for activities in customer service situations, such as food preparation, food handling, food delivery, doorperson activities, and telephone answering skills. ENVIRONMENTAL, AGRICULTURAL & NATURAL RESOURCES SUBTITLE: LANDSCAPING SKILLS Students interested in this cluster are preparing for outdoor work experiences such as landscaping, mulching, conservatory work, and horticultural experience.


137

HEALTH & BIOSCIENCES SUBTITLE: PERSONAL MANAGEMENT and SELF-AWARENESS SKILLS Students interested in this cluster are preparing for all activities of daily living through mastery of personal management including but not limited to proper toileting, proper hand washing, appropriate social interaction with peers and adults. HUMAN RESOURCE SERVICES SUBTITLE: RECREATION AND LEISURE SKILLS Students interested in this cluster are preparing to function with some independence and choice in their ability to access community based recreation and leisure activities. INFORMATION TECHNOLOGY SUBTITLE: COMPUTER & ASSISTIVE TECHNOLOGY SKILLS Students interested in this cluster are preparing to access the internet for business or social interaction and assistive technology aids for better performance in daily living activities. MANUFACTURING, ENGINEERING & TECHNOLOGY SUBTITLE: VOCATIONAL WORKSHOP SKILLS Students interested in this cluster are preparing to work in activities offered in a vocational center including clerical work, labeling, packing boxes, sorting, and assembly skills. TRANSPORTATION TECHNOLOGIES SUBTITLE: SAFETY IN THE COMMUNITY SKILLS Students interested in this cluster work on learning basic independence

in the community including safety in public situations, street crossing,

awareness of danger, food safety, and a general understanding of

household safety measure


138

TRANSITION CAREER CLUSTERS (pg 1)

STUDENT NAME: GRADE:

Career Cluster Exposure/Date Achieving Initials

Arts, Media &

Communication

Business Management

& Finance

Construction &

Development

Consumer Service,

Hospitality &

Tourism

Environmental,

Agricultural &

Natural Resources


139

TRANSITION CAREER CLUSTERS (pg 2)

STUDENT NAME: GRADE:

Career Cluster Exposure/Date Achieving Initials

Health & Biosciences

Human Resource

Services

Information

Technology

Manufacturing,

Engineering &

Technology

Transportation

Technologies


140

REVIEW OF SKILLS CHECKLISTS

Student:____________________________________________________

Date:________________________

Reviewed by:_______________________________________________

Readiness

Basic Work Skills

Matching and Sorting

Pre-reading

Number & Quantity Concepts

Group Skills

Social Skills

Vocational Skills

Use this form as necessary when any of the checklists have been previously

completed. Please initial and date the original form found in the previous graded

section of the portfolio, copy, and file in this section. Return the original to its

proper place.

If the student has not had any of the skills checklists completed previously record

the information in the longer forms in the binder.

Counseling & Advisory (C) 8, 9, 10 (Circle One)

141

INITIAL TRANSITION PLANNING Ages 14-16 Student Name: Date of Birth: Age:

Course of Study Coordinated set of transition activities

Linkages Parent Survey Post-school Outcome

Academic

Activities of Daily Living

Employment Training

Social Interaction Skills

Behavioral


142

Fine Motor/ Eye Hand Integration date (8th

) date (9th) date (10

th) date (11

th) date (12

th)

1. Pick up and explore objects

- using 1 hand

- using 2 hands in coordination

- using hands and eyes together

2. Put items purposefully in specific location

- place on surface without dropping

- put into open container

- put into snug container

3. Pull items apart

- requiring only 1 hand

- using 2 hands

4. Put items together

- requiring only pushing w/1 hand

- using 2 hands

5. Stabilize materials being worked on

- hold down to table or other surface

- hold relative to other hand/material being used

- manipulate relative to other hand/material being used

6. Pick up small objects

- using hand grasp

- using finger grasp

- using pincer grasp

7. Complete inset puzzles

- up to 6 pieces

- 6+ pieces


143

Imitation

date (8th


th) date (11

th) date (12

th)

1. Respond to imitation of own actions

- pause? look? repeat?

2. Imitate rhythmic motor movements paired with sounds

- 1:1 play with adults

- small group setting with peers

- peek-a-boo, pat-a-cake, row the boat, etc.

- circle-time songs

3. Imitate 1-step motor actions using interesting objects

- 1:1 play with adults


- car, hammer, playdoh, crayon, doll, etc.

4. Imitate 1-step actions using body

- 1:1 with adults


- clap, stomp, jump, wave, touch, etc.

5. Imitate fine motor movements

- 1:1 with adults


- manipulating materials

6. Imitate fine and oral-motor movements of body

- 1:1 with adults


7. Respond to adult‘s imitation of own sounds/words

- pause? look? repeat?


144

date date date date date 8. Imitate sounds/words with rhythmic action

- repeated sound/word to accompany large body movements

- repeated sound/word to accompany use of objects

9. Imitate words or word approximations on request

- within context of meaningful activity

10. Imitate phrases and/or simple sentences

- within context of structured, meaningful activity

11. Imitate peer language

- within context of structured, meaningful activity

- within context of everyday peer interactions

12. Generalize use of imitated language

- learned in one setting and used in similar but new setting

- borrowed language from TV or videos

- routine phrases


145

Group Skills

date (8th


th) date (11

th) date (12

th)

1. Observe group activity from a distance

- note specific activity

2. Approach structured group activity for short periods of time

- note specific activity

3. Stay with group during short activity (1 to 5 minutes)

- given individual materials to manipulate

- note visual structure used to define area

4. Stay with group during activity to completion (up to 10 minutes)

- given visuals/manipulative component to activities

- note visual structure used to define area/activities

5. Participate in circle-time songs/games by listening and watching

- note specific activity/adaptations

6. Participate in circle-time songs/games by imitation


7. Participate verbally in circle-time songs/games


8. Participate in circle-time by looking at/listening to book

- note specific book/adaptations

9. Participate in circle-time by making choices of activities

- note visual choice system used

10. Participate in teacher-led group games by waiting/taking turns

- note visuals used


146

date date date date date 11. Participate in group games involving motor imitation (Simon Says, Follow the Leader, etc.)

- note specific games and adaptations

12. Participate in group games by passing out to/collecting materials from peers

- note specific games/materials/adaptations

13. Participate in group games involving taking turns with peers

- note specific games/adaptations

14. Generalize group skills to larger group settings with less physical structure

- note specific activities/settings


147

Social

date (8th


th) date (11

th) date (12

th)

1. Play comfortably in proximity to adults

- note who and where

2. Approach adults for comfort when hurt or distressed

- note who and why

3. Look briefly to adults to monitor behavior

- note who

- note why

Share attention

Permission

Clarification/information

Assistance

4. Play in proximity to peers

- tolerate noise and movement without avoiding/becoming upset

- in teacher-led, structured settings

- in free play settings in classroom centers

- note length of time

5. Parallel play alongside peers

- without taking others toys or hoarding materials

- in teacher-led, structured settings


- note length of time

6. Observe/watch others

- note who and in what activities

- in teacher-led, structured settings involving interesting materials



148

date date date date date 7. Respond to/cooperate with others (1-step)

- give out/share materials with adult mediation

- respond to peer initiation with adult mediation

- notice when others imitate his/her actions

8. Imitate others in teacher-led, structured activities

- imitate use of objects

toys, musical instruments, art materials, etc.

- imitate body movements

parts of songs or routines

on cue or to achieve a goal

- vocal/verbal imitation

part of song or routine


9. Imitate others in free play settings in classroom centers

- imitate use of objects

toys, musical instruments, art materials, etc.

- imitate body movements

parts of songs or routines


- vocal/verbal imitation

part of song or routine


10. Initiate contact with others to continue an interrupted enjoyable activity

- note who and what activities

11. Initiate contact for spontaneous play with others



149

date date date date date 12. Take turns with an adult in structured settings

- note visual cues used for turn-taking

- wait for turn/watch others‘ turn

- anticipate/offer turn

13. Take turns with peer(s) in teacher-led, structured settings

- note visual cues used for turn-taking

- wait for turn/watch others‘ turn

- anticipate/offer turn

14. Take turns with peer(s) in free play in classroom centers


15. Follow simple rules in teacher-led, structured games

- table-based games (at 1:1 teaching, in centers)

- motor games (at circle, outside)

16. Follow rules in peer play

- knows rules are for everyone/sense of ―fairness‖

- table-based games

- motor games


150

Cognitive/Readiness Skills date (8th


th) date (11

th) date (12

th)

Basic Work Skills

1. Attend to materials

- searches out hidden items

- explores cause and effect

- tracks movements

2. Work to completion of activity(-ies):

- all materials either ‗disappear‘ or are affixed to a surface

- all materials are used

- all instructions are completed

3. Anticipate work routine/follows work system (note details on work system

worksheet)

- indicates ‗finished‘ by placing items in designated place (in a container, on a shelf, etc.)

- at work settings

- in other settings (play centers, snack, group, etc.)

- completes activity(-ies) independently

- at work settings

- in other settings (play centers, snack, group, etc.)

4. Inhibit motor responses to increase scanning

- field of 2 items

- field of 3-5 items

- field of 6+ items

5. Attend to visual directions (note details on visual instructions worksheet)

- approaches materials left-to-right

- follows simple model

- looks for instructions before beginning activities


151

date date date date date Matching and Sorting

1. Complete inset puzzles

- up to 6 pieces

- 6 or more pieces

2. Sort 2 dissimilar objects

- with self-correcting container organization format

- to sample, with open containers

3. Sort (into containers) items for 1 visual dimension (object, color, shape)

- field of 2-6

- field of 6+

4. Match (onto surface) items for 1 visual dimension (object, color, shape)

- objects

- pictures


- field of 6+ items

5. Match/sort items for more than 1 visual dimension (object, color, shape,

details)

- objects or pictures


- field of 6+

6. Complete jig-saw puzzles (connecting pieces)

- up to 6 pieces

- 6+ pieces

7. Match objects to pictures (or reverse)

- identical match

- non-identical


- field of 6+


152

date date date date date 8. Assemble stacking/nesting toys by size

- up to 4 pieces

- 4+ pieces

9. Sort items into categories by polar concept

- big/little

- clean/dirty

- good/broken

- hard/soft

- wet/dry

- hot/cold

10. Sort items into functional categories

- field of 2 categories (foods, clothing, people, animals, vehicles, toys)

- field of 3-4 categories (as above)

- sub-categories (rooms of the home, wild v. tame animals, clothing

for seasons, girls v. boys, etc.)

11. Match items by functional association

- pair things that go together

Number and Quantity Concepts

1. Place items in 1:1 correspondence

- self-correcting, into fitted space

- onto visual cue

2. Match/sort numerals

- 1-5

- up to 10

- 10+


153

date date date date date 3. Identify numerals

- in order

- out of order

- 1-5

- up to 10

- 10+

4. Count sets of objects and match to numeral

- 1-5

- up to 10

- 10+

5. Create/give sets of objects for numerals

- 1-5

- up to 10

- 10+

6. Place numerals in order

- 1-5

- up to 10

- 10+

7. Fill in missing numerals in sequence

- 1-5

- up to 10

- 10+


154

date date date date date Pre-reading

1. Match/sort alphabet letters

- identical

- non-identical but all same case

- upper case and lower case

2. Place alphabet letters in order

- fills in missing letters in alphabetical sequence

- creates alphabetical sequence

3. Match letters sequentially to duplicate words

- match letters with left-to-right sequence to form words

- match pre-written short words

4. Identify own printed name

- from field of 2

- across a variety of settings

5. Match/sort short words

- high use such as names, colors, schedule, etc.

- high interest such as toys, foods, pets, etc.

6. Match (read) sight words to objects or pictures

- high use such as names, colors, schedule, etc.

- high interest such as toys, foods, pets, etc.

7. Read/follow simple 1-2 word printed directions (read for information)

- go get item

- place item in location

- perform action with object

- give item to person


155

Expressive Communication

date (8th


th) date (11

th) date (12

th)

1. Cooperate in routines with adult (adult builds routine based on child‘s

interests)

- movement and sensory activities

swinging, tickling, deep pressure, etc.

- use of interesting toys/materials

roll cars, play xylophone, wind-up toys, balloon, etc.

- vocal/verbal routine

sing song, finger play, counting, etc.

2. Anticipate/participate in routines as above (some joint attention, eye

contact, spontaneous participation)

- movement and sensory activities

- use of toys and materials

- vocal/verbal routines

3. Indicate desire for routines (as above) to continue if disrupted

- attempt to restart routine motorically

- attempt to restart routine using materials

- attempt to restart routine vocally or with gestures

4. Seek attention of adults for play or assistance

- approach and/or eye gaze

- use physical contact

- use materials

- use gestures or vocalizations

5. Refuse objects/reject actions (non-preferred food, toy, activity)

- use physical contact/pushing away

- use gestures or vocalizations

6. Request by guiding adult hand to desired objects, actions, locations

- for objects, actions, locations


156

date date date date date 7. Request using object exchange

- foods, toys, activities, songs

8. Request using picture exchange

- foods, toys, activities, songs, people

- note if photos, labels, drawings, icons

9. Indicate choices using object exchange

- foods, toys, activities, songs, etc.

- note # of options

10. Indicate choices using picture exchange


- note # of options and if photos, labels, drawings, or icons

11. Indicate choices using printed words


- note # of options

12. Direct activity by indicating next steps

- note system used (motor/gesture/objects/pictures, etc.)

- note # of steps

13. Seek help and/or permission

- note system used (as above)

14. Seek information about things in surroundings

- what things are, how things work, where things are

- note system used


157

date date date date date 15. Show persistence in communication strategies

- initiate without prompting

- attract and maintain attention

- repeat message

16. Direct gestures and facial expressions to clarify communication

- point, nod/shake head

- smile, frown, puzzled, icky, shrug, etc.

17. Seek to repair miscommunication with alternate strategy

- seek proximity and eye gaze

- volume

- gesture/pantomime

18. Use spoken words to communicate basic needs and wishes (note

use of visual supports for teaching, independence, and back-up)

- request

for objects, people, activities, locations, etc.

for possession (mine, gimme)

for recurrence (more, again)

- make choices

note size of array choosing from

- reject/refuse

no, not, stop, don‘t, etc.

- accept/agree

yes, OK, alright

- direct activities

note # of steps

- seek information/assistance/permission

use of intonation patterns

question forms


158

date date date date date 19. Use spoken words to comment

- comment to others about objects

- comment to others about surroundings/activities

- share information about current activity

20. Use spoken words for simple interactions with others

- greetings and farewells

- to invite to join in activity

- to show/share materials/activity

21. Language includes variety of grammatical categories

- nouns, including names

- actions and other verbs

- location words and phrases

- attributes/descriptors/category words


159

READINESS SKILLS CHECKLIST KEY

F=Full assistance

M=Moderate assistance

E=Emerging Independence

I=Independent

BASIC WORK SKILLS DATE DATE DATE DATE

1. Attends to verbal directions

-independently

-with prompts

2. Attends to visual directions

-focuses on job

-independently

-with prompts

-approaches materials from left-to-right

-follows a simple model

-scans materials

3. Attends to materials

-scans for materials

- all materials are used

-indicates finished product

4. Works to completion of activity

-work endurance 0-5 minutes




-work endurance 30 minutes or more


160

Adapted from TEACCH curriculum workbooks/TTAP 7/7/09.vsb


161

READINESS SKILLS CHECKLIST II KEY

F=Full assistance



I=Independent

MATCHING AND SORTING DATE DATE DATE DATE

1. Matching

-colors in a field of 2


-objects in a field of 2


-shapes in a field of 2

-shapes in a field of 3

2. Sorting



-sorts dissimilar objects

-sorts by similar category

-sorts into category by polar concept (big/little, hard/sort)

-sorts by functional category (food, clothing, people)

4. Assembly

-stacking

-collating (3 papers/cards)

-follows a simple pattern

-assembly of items (2 pieces)

-assembly of items (3-5 pieces)


162


Counseling & Advisory (A) 8, 9, 10,

11, 12 (Circle One)

Student: ___________________________________________________________________________

163

READINESS SKILLS CHECKLIST III KEY

F=Full assistance



I=Independent

NUMBER AND QUANTITY CONCEPTS DATE DATE DATE DATE

1. Place items in 1:1 correspondence

2. Matching

-single digit numbers

-double digit numbers

3. Sorting

-single digit numbers

-double digit numbers

4. Identification of numerals

-in order single digit numbers

-in order double digit numbers

-out of order single digit numbers

-out of order double digit numbers

5. Count sets of objects

-1-5

-up to 10

-by dozens

Counseling & Advisory (A) 8, 9, 10,

11, 12 (Circle One)

Student: ___________________________________________________________________________

164

6. Packages objects

-independently

-with a template

-single items

-2-5 items

-6+ items Adapted from TEACCH curriculum workbooks/TTAP 7/7/09.vsb

Student: _____________________________________________________________________

165

READINESS SKILLS CHECKLIST IV KEY

F=Full assistance

M=moderate assistance


I=Independent

PRE-READING DATE DATE DATE DATE

1. Match/sort alphabet letters

-identical

-non-identical but all the same case

-upper and lower case

-creates alphabetical sequence

-filing by alphabetically

-collating alphabetically

2. Match letters sequentially to duplicate words

-match letters with left-to-right sequence to form words

-match cursive writing to printed word

3. Identify own printed name

-from a field of 2

-from a field of 5

-across a variety of settings

5. Match (read) sight words to objects or pictures

-high use words such as names, colors, schedule, etc.

up to 5 words

+10 words

+25 words

Student: _____________________________________________________________________

166

+ over 26 words

6. Read/follow simple 1-2 word directions

-get item and give the item to a person

-perform an action with an item Adapted from TEACCH curriculum workbooks/TTAP 7/7/09.vsb

Student: _____________________________________________________________________

167

Interview Questions

Name: Date:

What do you like to do?

What do you do well?

What are your needs?

Leisure

Leisure

School

Community

Family

Work

Other

Team Player

Punctual

Friendly

Good Worker

Other

Listen

Communication

Transportation

Learning

Personal Care

Support

Other

Student: _____________________________________________________________________

168

Retail

What work experiences have you had?

What work experiences have you had?

Food Service

Custodial

Clerical

Landscaping

Other

What work experiences did you like?

What work experiences have you had? Retail

Food Service

Custodial

Clerical

Landscaping

Other

What work experiences did you not like?

What work experiences have you had? Retail

Food Service

Custodial

Clerical

Landscaping

Other

What would you like to do after high school?

What work experiences have you had? Work

Independent Living

Adult Education

Friends

Leisure

Other

Counseling & Advisory (A) 9, 10, 11, 12 (Circle One)

Student: ____________________________________________________________________

169

GROUP SKILLS CHECKLIST KEY

F=Full assistance



I=Independent

BASIC GROUP SKILLS DATE DATE DATE DATE

1. Approach structured group activity for short periods of time

2. Stay with the group for a short activity (1-5 minutes)

3. Respond to name and give appropriate greetings

-with prompts

-independently

4. Participate actively with a group activity

-demonstrate positive behavior with familiar people

-demonstrate positive behavior with strangers

-wait appropriately

-take turns appropriately

-shares objects appropriately

-engage in a leisure activity with peers

5. Respond appropriately to physical contact with others

6. Work cooperatively with peers and adults

-share materials

-acknowledge peers

-understand and accept authority figures

-ask for assistance appropriately

Counseling & Advisory (A) 9, 10, 11, 12 (Circle One)

Student: ____________________________________________________________________

170

-follow visual rules

-follow verbal rules


Counseling & Advisory (A) 9, 10,

11, 12 (Circle One)

Student:_____________________________________________________________________

171

SOCIAL SKILLS CHECKLIST KEY

F=Full assistance



I=Independent

BASIC SOCIAL SKILLS DATE DATE DATE DATE

1. Engage in a leisure activity in proximity to adults

2. Engage in a leisure activity in proximity to peers

-tolerate noise and movement without avoiding/becoming upset

-in teacher-led activities

-in leisure activities

3. Respond to and cooperate with others (1-step)

-share/give out materials to peers with adult mediation

-respond to peer initiation with adult mediation

-observe/notice peers

4. Imitate

-use of objects/games

-body movements in leisure setting

-vocal/verbal imitation in leisure setting

5. Initiate contact with adults for leisure activities

6. Initiate contact with peers for leisure activities

7. Take turns with adults in leisure activities


11, 12 (Circle One)

Student:_____________________________________________________________________

172

8. Take turns with peers in leisure activities

9. Follow simple rules for table and motor games



11, 12 (Circle One)

Student:_____________________________________________________________________

173

VOCATIONAL SKILLS CHECKLIST KEY

F=Full assistance



I=Independent

VOCATIONAL SKILLS DATE DATE DATE DATE

1. Understands the work environment

-know what is expected each day

-be willing to work each day

-show respect for property, rules, and regulations at work

2. Communicate appropriately

-ask for assistance appropriately

-ask for directions

-work well in proximity of others

-recognize authority figures

3. Follows instructions verbally or visually

-attempts new tasks

-handles transitions well

-responds appropriately to directions

-tolerates interruptions

-adjusts to changes in routine

4. Endurance

-works with assistance

-works steadily

-works independently

-increase time on task from 10-20 minutes

from 20-30 minutes


11, 12 (Circle One)

Student:_____________________________________________________________________

174

from 30-45 minutes

from 45-60 minutes

+60 minutes Adapted fro

Documents

MANSEF Functional Career Development Portfolio