Project SEARCH Application

Transcription

1 Prject SEARCH Applicatin fr INFORMATION FOR STUDENTS AND PARENTS/GUARDIANS: Students must pursue and maintain services frm Opprtunities fr Ohians with Disabilities (OOD)/BVR r Bridges t meet Eligibility and Order f Selectin criteria. Submit a cmpleted MVCTC/Prject SEARCH applicatin t yur student s lcal district f enrllment. Applicatins are Due n later than Feb. 10, 2017 Applicatins will be reviewed by a Screening Cmmittee, which will make recmmendatins t the Instructin Department at MVCTC cncerning placement in the prgram n a cnditinal basis fr an initial 45 day trial perid. STUDENTS WILL BE NOTIFIED OF PROGRAM PLACEMENT Later than April 2017 (Students will als be ntified by letter if they are nt accepted at this time). Students must participate in a hands n assessment and interview prcess at the Prject SEARCH Miami Valley Hspital Suth lcatin prir t acceptance int the prgram. Miami Valley CTC will ntify f interview time. Students wh enter the prgram, will serve a 45-day trial perid t determine whether they cntinue t meet the prgram eligibility criteria as utlined by MVHS Prject SEARCH. It is recmmended that students and parents attend prgram pen huses and/r visit Prject SEARCH prgrams prir t applying whenever pssible. Fr mre infrmatin please cntact Teresa Rayple at trayple@mvctc.cm r RESIDENT SCHOOL DISTRICT RESPONSIBILITIES: Please submit ne cpy f all dcuments and infrmatin listed in the applicatin checklist fr each student applying fr Prject SEARCH. Prepare new IEPs fr students accepted int Prject SEARCH in cnjunctin with prgram instructr during the spring f Instructr will send IEP cmpliance guidelines with acceptance letter. Review and sign the cmpleted applicatin with all necessary dcumentatin. Students must submit a cmplete Prject SEARCH applicatin packet thrugh their Resident Schl District t: Theresa Lingenfelter, Satellite Supervisr, Miami Valley CTC, 6800 Hke Rad, Englewd, Ohi 45315

2 Be at least 18 years f age. Prject SEARCH Entrance Criteria Cmpleted high schl credits necessary fr graduatin. Agree that this will be the last year f students services, and will accept diplma at the cmpletin f Prject SEARCH. Meet eligibility requirements thrugh Opprtunities fr Ohians with Disabilities agency (OOD frmerly BVR/BSVI). Meet eligibility requirements fr the Develpmental Disabilities Services and ther service prviders as applicable fr fllw alng services (this is preferred but nt necessary). Have independent persnal hygiene and grming skills Maintain apprpriate behavir and scial skills in the wrkplace. Take directin frm supervisrs and change behavir. Be able t cmmunicate effectively. Utilize public transprtatin when available and participate in travel training t ensure success in using the bus independently. Be able t pass drug screen, backgrund check, and have up-t-date immunizatins. Be willing t cmply t hst site nn-smking envirnment. Be willing t cmply with any ther hst site immunicatin requirements, healthand safety criteria, as-well-as cmpletin f rientatins and nging prfessinal develpment. Have the desire t wrk cmpetitively in the cmmunity. Please send applicatin t: Theresa Lingenfelter, Satellite Supervisr Miami Valley Career Technlgy Center 6800 Hke Rad Englewd, Ohi Or fax t:

3 Applicatin Packet Checklist Parent: Cmpleted Applicatin Packet and submit t lcal district f enrllment. Pht ID (Driver s License r State ID) Immunizatin Recrd Medical and r DSM Psychlgical Diagnsis with supprting dcumentatin frm persnal physicians/psychlgists (nt schl terminlgy) (t assist with OOD/BVR eligibility requirements) Cpy f Cunty Bard f DD eligibility instrument (OEDI) if applicable Cpy f Guardianship Curt Dcuments if applicable Parent and/r Schl: Cmpleted Transitin Skills Checklist Wrk Based Perfrmance Reprt(s) (wrk study r ther) Schl: Current cpies f Individual Educatin Prgram (IEP) Current cpies f Evaluatin Team Reprt High Schl Transcript(s) Attendance Recrd(s) Submit all dcumentatin and applicatin t MVCTC *If accepted int the prgram, a TB test, flu sht, cmplete backgrund check including fingerprinting, and ther similar requirements may be required.

4 Applicatin fr Admissin Male Female Student Name: Last First Middle Student Address: City: State: Zip: Student Cell Number: Hme Phne Number: DOB: / / Student date f 22 nd Birthday: / / Student Address: Student Shirt Size: Adult Small Adult Medium Adult Large Adult X-Large Adult 2 X-Large Schl District f Residence: Schl Last Attended/Presently Attending: IEP Case Manager Name: Phne: Parent/Guardian Infrmatin: Is Student his r her wn guardian? *If n, please attach curt dcuments Custdial Parent #1: Custdial Parent #2: Name: Relatinship: Wrk Phne: Emplyer: Cell Phne: Address: Hme Address if different frm Student: Name: Relatinship: Wrk Phne: Emplyer: Cell Phne: Address: Hme Address if different frm Student:

5 Educatinal Needs and Gals (please circle) Will the student have all credits necessary t meet graduatin requirements at the end f his academic year? Has the student ever been placed n a behaviral plan while in high schl? If yes, please attach t the applicatin with any supprting dcumentatin. Has the student been invlved in the curt system? If yes, please describe: Other than public educatin, has the student received any additinal frmal training? (Bridges, RSC, Gdwill, etc ) Emplyment Needs and Gals (please circle/answer) What are the student s emplyment gals? Des the student want t wrk part-time r full-time? Des the student plan t wrk during the schl year utside Prject SEARCH? If yes, please list: Hw many hurs per week? Des the student currently wrk ver the summer break? If yes, please list: Hw many hurs per week? Des the student have previus paid wrk experience OUTSIDE f the schl prgramming? If yes, please prvide details requested belw: Emplyer Jb Title Hurs/Week Supervisr Phne # Cmpetitive Emplyment (fading supprt) Part-time 20 hrs week Supprted Emplyment (enclave) Full-time 40 hrs week Dates f Emplyment

6 Emplyment Needs and Gals (cntinued) Did the student receive jb caching r accmmdatins? If yes, please explain: Has the student ever been fired frm a jb? If yes, please explain: Has the student ever quit a jb? If yes, why? Outside Activities/Extracurricular/Vlunteer Experience Organizatin Vlunteer Duties Hurs/Week Supervisr Phne # Dates f Service Supprt Services Has the student eligible fr services frm Opprtunities fr Ohians with Disabilities?(Frmerly RSC/BVR) If yes, please list cunselr name and phne number: Cunselr Name: Phne: Is the student SSI r SSDI eligible? If yes, please attach award letter. Is the student eligible fr services frm Cunty Bard f DD? If yes, please list DD service supprt crdinatr s name and phne: Crdinatr Name: Phne: If n, is the student interested in applying fr DD Eligibility?

7 Supprt Services (cntinued) Has the student utilized services frm ther agencies in the past? If yes, prvide the details requested belw: (mental health, etc.) Agency Services Prvided Agency Cntact Phne # Dates f Service Living Arrangements and Daily Care Wh des the student live with? Please list name and relatinship: Des the student set and use an alarm independently? Des the student get up in the mrning n his/her wn? Des the student perfrm daily care n his/her wn? (bathing, grming, dressing, etc.) Assistance Minimal Assistance Occasinal Assistance Ttal Assistance If assistance is needed, wh assists the student? Medical Histry Please list student s medical and psychlgical diagnsis: Des the student have allergies? If yes, please describe. Des the student take medicatin n a regular basis? If yes, please prvide details requested belw: Medicatin Purpse Dsage Amunt Dsage Schedule Prescribing Physician Physician Phne #

8 Medical Histry (cntinued) Des the student use any devices r aid t assist with his/her hearing? If yes, please explain the nature f his/her hearing impairment: Des the student have an Emergency Plan? (seizure plan, etc.) If yes, please attach. Future Planning Des the student currently hld a driver s license? Des the student currently hld a temprary driving license? Can the student travel t the wrkplace using public transprtatin? Disability Awareness In the students wrds, please describe his/her disability and the effect it has n daily actvities at schl, hme and in the cmmunity. (A Scribe can be used if apprpriate) Please list the names and rles f the IEP team members that

9 cmpleted this applicatin: Name Agency Phne Number Parents/Guardians: Permissin is granted fr my sn/daughter t apply fr admissin t MVCTC. I als, hereby, grant permissin fr any requested student recrds, state test scres, t be released t MVCTC. The student infrmatin will nly be disclsed t schl fficials and authrized representatives. This district will nt re-disclse the infrmatin. A current cpy f the students IEP, ETR, and transcript will need t be attached t this applicatin when submitted. Signature f Applicant Signature f Guardian/Parent Date Date

10 I agree t the release f all pertinent schl and medical recrds t the Prject SEARCH staff and Prject SEARCH Screening Cmmittee. Student Signature: Parent Signature: Legal Guardian Signature: Date: Date: Date:

11 The Miami Valley Career Technlgy Center is dedicated t prviding equal admissin pprtunities, equal educatinal pprtunities, and equal emplyment pprtunities withut regard t race, religin, clr, natinal rigin, ancestry, age, sex, sexual rientatin, handicap, marital status r veteran status. *T be cmpleted by partner schl cunselr. Please attach student s transcript. Is this student a resident f yur schl district? If n, list status (example: Open Enrllment, Tuitin, Curt Placed, etc.) Attendance (List number f days absent): Is English the student s secnd language? If yes, what language is spken in the husehld: Cunselr Cunselr Applicatin Check-Off: Parent Signature Attendance Transcript ETR IEP Transitin Checklist Wrk Based Perfrmance Cunselr Signature: Date:

12 Transitin Skills Checklist T Be Cmpleted by IEP Team Evaluate the student n the belw criteria. Parents please place a P and schl districts place and S t the right f the examples that yu feel best describes the current perfrmance level f the student. Please add additinal cmments and attach any evidence that help clarify yur ratings. Student Schl Date Emplyability Student has nt had any emplyability skills training Student has participated in limited r infrmal training fr emplyability Student has had ne year r a cnsistent class devted t emplyability skills in at least a small grup caching experience Student has had mre than ne year f emplyability skills in a semi-independent t independent setting Wrk and r Vlunteer Experience Student des nt have any wrk related experience in the cmmunity r in the schl setting Student has supprted wrk experience in a nen-ne setting; very little pprtunity fr independent wrk Student has supprted cmmunity and r wrk experience in a small grup setting; pprtunities fr independently wrking Student has independent wrk r vlunteer experience in the cmmunity Cncept f Wrk Des nt display interest r desire t want t wrk Talks abut wrk, but is very limited in knwledge f wrk and jb preferences Able t identify jbs f interests thrugh pictures but nt able t describe the task cmpletely Verbalizes definitin, names jbs, ID jb in pht r drawing, translates int actin n task, wants t wrk Interests Struggles with cmpleting a survey t cmmunicate interests Struggles with cnsistently identifying likes and dislikes r jb preferences except with when with direct assistance t interpret the pictures; cmpletes an interest survey with minimal assistance; able t identify likes and dislikes; Has established jb interest with frmal survey; cmmunicates preference, talks abut certain jbs; verbalizes / cmmunicates interest when questined; Values Student des nt exhibit pride in the wrk perfrmed; disrespectful t peers and staff Student has exhibited nt always being truthful abut situatins; cmpletes wrk but des nt seem t care if the wrk is crrect r nt; needs cntinued prmpts Student attempts all tasks with a psitive attitude; wrks t cmplete jbs crrectly; needs limited prmpts Hnest, takes pride in wrk, keeps wrk area neat, etc. Initiative Sits dwn r wanders after tasks are cmpleted With prmpting the student will ask fr mre wrk; des nt initiate new task Student will ask fr new r next task independently, but des nt initiate anther task withut prmpting Will ask fr r find ther wrk independently when apprpriate Cncept f Speed Des nt demnstrate cncept f speed Understands the meaning f "fast" but struggles t implement a faster pace while cmpleting the jb Understands the meaning f "fast" and is able t increase wrk pace fr a shrt perid f time, but still requires prmpting t increase pace again Verbalizes meaning f "fast"; visibly wrks faster with reminders, can wrk against the clck, n timer, with acceptable quality, etc.

13 Attentin t detail and quality Needs prmpts fr task cmpletin; needs instructin n checking wn wrk; makes frequent errrs/mistakes Needs prmpts fr task cmpletin; needs prmpts n checking wn wrk Task cmpletin with quality is clse t 100%; student needs ccasinal prmpting t check wrk Finishes tasks crrectly, checks wn wrk, will red wrk fr crrectins Fcus n Task Distracted by mvement, visual, auditry - distracts self - plays with materials; unable t fcus n task Very easily distracted and nt able t get back n task withut several prmpts; and supervisin Distracted by sme sunds, mvement, visual, auditry but is able t get back n task withut independently Student can fcus n a given task with multiple distractins ccurring. Stamina Student is able t attend t physical requirements f a jb-related task fr at least 30 mins. in the classrm r wrkplace setting Student is able t attend t physical requirements f a jb-related task fr ne hur in the classrm r wrkplace setting Student is able t attend t physical requirements f a jb-related task fr tw hurs in the classrm r wrkplace setting Student is able t attend t physical requirements f a jb-related task fr mre than three hurs in the classrm r wrkplace setting Mbility Student is unable t travel in a standard vehicle - requires adaptive transprtatin, such as a lift fr a wheelchair; unable t balance while standing Student has sme mbility cncerns; needs sme supprt with equipment and navigating envirnment - elevatr, stairs, etc.; balance standing is a cncern and needs accmmdating Student has minr mbility issues - needs access t an elevatr r ramps; is able t use the equipment independently; can be respnsible with an elevatr key; n cncerns with balance Individual des nt have any mbility cncerns; is able t maneuver envirnment independently; n prblems with balance Lifting Student is able t lift 20 punds Student is able t lift 30 punds Student is able t lift 40 punds Student is able t lift at least 50 punds Living Skills Student needs ttal assistance t cmplete basic husehld chres; Student is able t cmplete basic husehld chres with cntinuus prmpts; cmpletes chres with checklist Student is able t cmplete basic self-chres with minimal prmpts, such as prepare a snack, wash wn dishes; Student is able t cmplete basic husehld chres with sme prmpting; Student is able t cmplete husehld chres fr the family with minimal t n prmpts, such as laundry, dishes, and vacuuming large areas; Able t pack a healthy lunch independently; Reading Able t identify letters A- Z; Able t read basic site wrds, struggles with sentences; needs instructin n the meaning f unfamiliar wrds related t the wrk place Able t read sentences; able t sund ut unfamiliar wrds; may need sme instructin with cmprehensin f read material Able t read paragraphs fr infrmatin and is able t cmprehend the materials that they just read

14 Math Able t identify numbers 1-20; has 1 t 1 crrelatin; can cunt bjects 1 t 20; able t identify cins and bills by name Able t cunt bjects 1 t 50; can add and subtract using a calculatr; able t tell time t the hur; able t identify cins and bills name and value Able t cunt bjects 1 t 100; can add and subtract simple equatins withut a calculatr; able t multiply and divide with a calculatr; can tell time t the half hur; able t identify cins and bills and cunt amunts f mixed cins and mixed bills; Able t cunt bjects; able t calculate simple additin, subtractin and multiplicatin withut a calculatr; able t tell time n an analg accurately; able t cunt back change and has demnstrated independent banking skills; Persnal Care Skills/Hygiene Student requires ttal assistance t care fr self, including tileting, persnal care needs, and/r feeding self prepared fd Student needs minimal verbal prmpts r minimal assistance with hygiene and persnal care Student may need reminders frm day t day n persnal hygiene, but majrity f the time is independent in self-care Student is independent in persnal care skills and needs n prmpting r reminders f apprpriate hygiene. Scial Skills Student exhibits scial skills and r behavirs that are nt apprpriate fr a cmmunity setting; Student des nt get alng well with thers Student peridically displays inapprpriate scial skills and behavirs; Student is able t get alng well with thers with supprts Student is apprpriate in the presence f adult supervisin but is nt independent; Student gets alng well with thers ccasinally Student independently exhibits scial skills and behavirs that are apprpriate fr cmmunity settings; Student gets alng with thers n a regular basis Interactin with supervisr Struggles fllwing directins; argues with staff abut directins; cmplains abut tasks; refuses t wrk; Tends t argue abut directins r will cmplain abut the directins being given; has been bserved displaying disrespectful attitude twards staff; argumentative Fllws directins with nly 1 r 2 questins; des nt cmplain r act in a defiant manner; respectful t staff and cmmunicates apprpriately Fllws directins as given withut cmplaints r defiance; Is respectful, nn-dependent, checks with supervisr apprpriately

15 Interactin with peers in wrk settings Scial Skills are inapprpriate fr the wrk setting; student is negative t peers, rude and usually des nt wrk as part f team; Scial Skills are apprpriate fr the wrk envirnment sme f the time; the student requires prmpts n apprpriate tpics fr the wrk setting; will wrk as part f team with prmpting and guidance; Scial Skills are apprpriate fr the wrk envirnment mst f the time; the student may need sme supprt fr apprpriate tpics; wrks as part f a team; des nt initiate a leadership rle within the team Scial Skills are apprpriate fr the wrk setting; student displays a psitive attitude twards wrking; student participates with a given team in activities; student is respectful t peers and their pinins Self-Advcacy Student is unable t advcate needs Student is able t advcate fr needs when given direct guidance Student is able t selfadvcate with minimal guidance Student is able t respectfully self-advcate needs with n guidance Fllws Directins Student is unable t fllw written, picture r verbal directins Student is able t fllw verbal directins with cntinuus prmpting; cannt utilize a checklist, written r picture checklist Student is able t fllw 2 t 3 step directins given by gestures and r pictures; minimal verbal prmpts are needed Student is able t fllw multiples step directins given either verbally, with pictures r written directins Safety Skills Student is unable t recgnize safe versus unsafe situatins in the hme, wrk place r cmmunity. Student requires prmpting t identify safe and unsafe situatins, adult supervisin is required 50% f the time. Student is able t identify mst safe r unsafe situatins independently; ccasinal minimal prmpts may be needed Student is independent in using safety skills at hme and in cmmunity settings Ability t wrk independently Student is nt able t wrk n trained task withut full supprt. Student is able t wrk n a task with limited supprt Independence is limited. Student is able t wrk independently fr at least 45 minutes n a trained task. Student is able t wrk independently fr at least 2 hurs n a trained task. Learning Styles Needs step-by-step directins verbally; minimal experience with a picture checklist; demnstratins and mdeling are difficult Able t fllw 1 t 2 step directins with prmpting; mdeling, hand-ver-hand and demnstratin are helpful, but nt a strength; Able t fllw 2 t 3 step directins; able t learn frm mdeling, practice pprtunities and repetitin; very minimal verbal prmpts' Able t fllw multi-step directins; able t use varius styles f checklists r task analysis; mdeling, repetitin and practice pprtunities strengthen their perfrmance f the skill;

16 Shape Discriminatin Student is still wrking n learning basic shapes (circle, square, triangle, etc.) Student is able t identify at least three basic shapes (circle, rectangle, val, etc.) Able t identify all basic shapes and tell differences between the basic shapes Able t identify basic and advanced shapes - (ctagn, pentagn, etc.) and tell large and small differences between them Size Discriminatin Student is learning t distinguish between size Student is able t tell large differences in size with sme prmpting Student is able t identify large differences in size and sme small differences is size with sme prmpting Student is able t identify bth large and small differences in the sizes f bjects withut any assistance r prmpting Spatial Student struggles t turn pieces, manipulate bjects t shw hw they cnnect r are jined; student requires cntinued supprt t cmplete tasks cntaining these skills Student is able t manipulate pieces in an up-dwn r side-t-side manner; turning pieces is a struggle, but will turn pieces with prmpting and instructin Student is able t manipulate pieces, turn/jin t accmplish a task with minimal t n assistance Understands bjects psitin in space - what ges up, dwn, etc.; Hw pieces are turned, jined, etc. Directinality Student struggles t decipher between right and left, up and dwn Student is nt cnsistent with right/left directins, but displays the cncept f left/right and up/dwn being ppsites Student is cnsistent with left/right directins n mst bservatins; sme assistance r reminders may need t be given ccasinally Understands bjects directin in relatin t ther bjects - knws which way t turn bjects (left r right), t pen/clse r lsen/tighten? Etc. Clr Discriminatin Student struggles t decipher between clrs Student is nt cnsistent with clr identificatin but is able t identify mst primary clrs Student is cnsistent with basic clrs, but struggles with shades f clrs in distinguishing between them Able t tell large and subtle differences in clrs Tl Handling Unable t manipulate small tls that require fine mtr skills Has sme experience with sme small tls, such as a screw driver, but needs instructin n using ther tls Has experience with mst small tls, able t use the tls independently with sme supprt, may need minr instructin n using thse tls Able t use and has experience using small tls (tweezers, small screw drivers, etc.) independently Cmputer Student needs assistance with all activities n the cmputer using Office prgrams and and navigating the Internet Student needs assistance with mst activities n the cmputer; able t type in Office; needs mre assistance with and Internet navigatin Student needs sme supprt n the cmputer; able t use Office fr typing; able t navigate the Internet independently with minimal assistance Student is independent n the cmputer using several prgrams, such as Office and Excel; Student has an accunt that is in use; Student navigates the Internet independently and is able t use a Search Engine withut assistance

17 IEP TEAM MEMBER SIGNATURE: IEP TEAM MEMBER SIGNATURE: IEP TEAM MEMBER SIGNATURE: PARENT SIGNATURE: STUDENT SIGNATURE: TITLE: TITLE: TITLE: TITLE: TITLE: DATE: DATE: DATE: DATE: DATE: