Student Name Date of Birth

Student Name Date of Birth:

DMPS Transition Skills and Linkages Checklist

This document is to be used for data collection/documentation and to lead discussions related to transition planning and to assist with the development of the student’s IEP (page B, goals and services). When an area is at a Level 1 for two consecutive reviews, you must contact your building Transition Coordinator for additional assessments and help with developing a plan to address the need.

KEY: 1 = Limited exposure or understanding

2 = Basic skills, some competence w/ support

3 = Advanced, able to perform w/ limited support

4 = Independent no support needed

Living

Skill Area
Food and Nutrition ( If needed 6-7) / 6 / 7 / 8 / 9 / 10 / 11 / 12 / Comments / Action / Source
Demonstrates manners
Clears /sets table
Prepares simple snacks / meals
Prepares food using recipe
Can describe healthy eating guidelines *
Washes dishes
Clothing Care ( If needed 6-7) / 6 / 7 / 8 / 9 / 10 / 11 / 12 / Comments / Action / Source
Dresses independently
Chooses appropriate clothing
Selects and buys own clothing
Does laundry
Does ironing
Wears clean clothing
Personal Management ( If needed 6-7) / 6 / 7 / 8 / 9 / 10 / 11 / 12 / Comments / Action / Source
Practices personal hygiene *
Brushes teeth
Gets self-up in morning
Personal Management (con’t.-If needed 6-7) / 6 / 7 / 8 / 9 / 10 / 11 / 12 / Comments / Action / Source
Demonstrates proper hair care
Demonstrates proper fingernail care
Makes appointments *
Meets scheduled appointments
Takes medication safely
Washes hands and face
Cares for nose
Has good self-concept
Shelter and Housing ( If needed 6-7) / 6 / 7 / 8 / 9 / 10 / 11 / 12 / Comments / Action / Source
Cleans own room
Makes bed
Vacuums
Takes out garbage
Basic repairs / (ex: change light bulbs, hang pictures)
Cleans bathroom
Communication ( If needed 6-7) / 6 / 7 / 8 / 9 / 10 / 11 / 12 / Comments / Action / Source
Uses phone
Uses email & internet
Knows how to get help in emergency
Ends conversations appropriately
Asks for assistance when needed
Listens when others speak
Initiates appropriate conversations
Financial Management / 6 / 7 / 8 / 9 / 10 / 11 / 12 / Comments / Action / Source
Knows values of coins and currency:
Can count coins and currency
Knows values of coins and currency:
Can make change
Knows how to pay for goods/services / (ATM, cash, write checks)
Can manage a savings account *
Can manage a checking account *
Financial Management ( If needed 6-7) / 6 / 7 / 8 / 9 / 10 / 11 / 12 / Comments / Action / Source
Can develop & maintain a budget *
Knows insurance * / (Health, Property, Auto, Life )
Saves money for specific purpose
Can describe difference between
needs and wants
Makes decisions about spending *
Community ( If needed 6-7) / 6 / 7 / 8 / 9 / 10 / 11 / 12 / Comments / Action / Source
Crosses street safely
Follows civic responsibilities *
Rides DART
Has a permit
Has taken drivers education
Has a license
Leisure Skills ( If needed 6-7) / 6 / 7 / 8 / 9 / 10 / 11 / 12 / Comments / Action / Source
Has at least one leisure interest in addition to TV
Can play table game with peers
Can arrange leisure event in a variety of places with others via phone or in person
Goes places with friends
Has a hobby
Personal Development ( If needed 6-7) / 6 / 7 / 8 / 9 / 10 / 11 / 12 / Comments / Action / Source
Demonstrates physical fitness *
Knows health risks
Understands mental health needs
Practices preventative healthcare *
Practices stress management *
Understands health services *
Relationships ( If needed 6-7) / 6 / 7 / 8 / 9 / 10 / 11 / 12 / Comments / Action / Source
Recognizes negative relationships
Develops and maintains friendships

Learning

General Skills ( If needed 6-7) / 6 / 7 / 8 / 9 / 10 / 11 / 12 / Comments / Action / Source
Uses digital tools/media to get practical day-to-day information *
Uses digital tools/media to get news independently *
Practices safe and responsible use of digital tools/media *
Can check out books from public library
Can state at least one area of interest for further study after graduation
Can state at least one vocational interest
Can state post-secondary plans that match interests and abilities
Describes disability and states needs related to it
Practices self-determination skills
Asks for accommodations
Can access community education classes

Working

General Skills ( If needed 6-7) / 6 / 7 / 8 / 9 / 10 / 11 / 12 / Comments / Action / Source
Has participated in volunteer/non-paid experience
Has worked to earn money
Has held a job for more than 3 months
Job Skills / 6 / 7 / 8 / 9 / 10 / 11 / 12 / Comments / Action / Source
Attends every day
Arrives on time
Notifies worksite if will be late or ill * / (notifies school)
Knows how to search for a job
Can read and complete job application
Knows how to interview for a job
Has sufficient physical/manual skills
for employment
Explores occupational possibilities
Can make a realistic occupational choice
Has good problem solving skills
Disagrees appropriately
Participates in conversation *
Responds appropriately to peers
Respects opinions of others
Initiates work related tasks *
Asks for work site assistance/accommodations
Job Skills(con’t) ( If needed 6-7) / 6 / 7 / 8 / 9 / 10 / 11 / 12 / Comments / Action / Source
Apologizes for mistakes, offenses, errors, etc. *
Follows directions
Remains on task *
Allows others to remain on task
Completes work in a timely manner *
Anticipates consequences of actions
Accepts responsibility for actions
Accepts differences in the workplace *
Produces high quality work *
Can meet employer’s needs *

Enter dates of review 8th grade 9th grade 10th grade 11th grade

* Aligns with 21st Century Skills

KEY: 1 = Limited exposure or understanding

2 = Basic skills, some competence w/ support

3 = Advanced, able to perform w/ limited support

4 = Independent no support needed

Student Name Date of Birth:

DMPS Transition Linkages Checklist

This section is designed to assist special education teacher, parents, and students in monitoring and documenting transition planning steps. Not all items apply to each student. The checklist should be updated at least annually in conjunction with IEP meetings. IHAPI will be used for some of this information.

Transfer of Rights

When to Complete / Date Completed / Completed
By / Activity / Transition Resource
Guide
2012 Edition
Prior to age 17 / Student/family made aware of transfer of rights at the IEP meeting when the student is age16 / Page 36
Prior to age 18 / Discussed guardianship, conservatorship, power of attorney option prior to age 18 / Pages 38 & 39
Age 18 / Student/family notified of transfer of rights at age 18
Prior to age 18 / Student/family contact attorney to explore guardianship options

Notes:

Post-Secondary Education

When to Complete / Date Completed / Completed
By / Activity / Transition Resource
Guide
2012 Edition
By 10th grade / Student discussed requirements of selected field and school options with counselor / Page 27-35
11th grade / Student narrows educational/training choices
By 12th grade / Student/family toured selected campus and department
By 11th grade / Student takes Compass/ACT test
12th grade / Student/family has met with special needs coordinator on campus share IEP and accommodations

School Explored: Date of Visit:

Vocational Rehabilitation

Contact using the direct phone and ask for a counselor: Direct Phone: 515-281-4211

When to Complete / Date Completed / Completed
By / Activity / Transition Guide
2012
10th grade / Referral made by 10th or 11th grade / Page 79-80
10th or 11th / Case file open

Invited representative to IEP meeting: Date:

Notes:

This section is designed to assist special education teacher, parents, and students in monitoring and documenting transition planning steps. Not all items apply to each student. The checklist should be updated at least annually in conjunction with IEP meetings.

Department of Blind

Counselor: Phone:

When to Complete / Date Completed / Completed
By / Activity / Transition Resource
Guide
2012 Edition
As soon as VI identified / Referral made / Page 80
Ongoing / Case file open

Invited Representative to IEP meeting: Date:

Notes:

Workforce Development/ Workforce Investment Act 1000 East Grand DSM, IA 50319

Phone Number: 1-800-JOB-IOWA

When to Complete / Date Completed / Completed
By / Activity / Transition Guide
2012
12th grade / Student/family made aware of services / Page 81
12th grade / Student/family have contacted agency

Notes:

Case Management/Service Coordination

Case Manager Name: Phone:

When to Complete / Date Completed / Completed
By / Activity / Transition Guide
2012
At any age / Parent/Student made aware of services available / Page 47-50
Age 17 / Discussed diagnosis of disability prior to age 18
Prior to age 17 / Referral made to Lead Agency
Residential and vocational service options discussed with family and case manager

Invited Case Manager to IEP meeting: Date:

Application for services completed-Date: By:

Eligibility Status:

Notes:

SSI

SSI is a government program through the Social Security office that makes cash payments to individuals. Individuals eligible for SSI are also eligible for Medicaid.

When to Complete / Date Completed / Completed
By / Activity / Transition Guide
2012
Any age / Student/family made aware of SSI / Page 54-56
Any age / Student/family have applied
Any age / Student currently receiving SSI

Eligibility Status:

When to Complete / Date Completed / Completed
By / Activity
Age 18 / Student/family made aware to reapply at age 18

Date:

Notes:

HCBS Waiver Services (ID, Ill, and Handicapped, Physical Disability, Brain Injury, Habilitation Services)

When to Complete / Date Completed / Completed
By / Activity / Transition Guide
2012
See IEP team / Student currently receives waiver services / Page 59-66
Contacted Lead Agency to explore waiver services
Discussed need for diagnosis prior to age 18

Applied for waiver services date: Eligibility Status:

Notes:

Estate Planning

When to Complete / Date Completed / Completed
By / Activity / Transition Guide
2012
Any time during high school / Student/family made aware of “special needs” trusts / Page 41
Any time / Student/family shared current IEP and accommodations

Notes:

Individualized Services by Outside Agencies

Service Provided: / Service Provided:
Agency Name: / Agency Name:
Contact Person: / Contact Person:
Phone Number: / Phone Number:
Additional Family/student agencies:

ASK Resource Center http://www.askresource.org/

Job Corp-Iowa http://www.jobcorps.gov/centerlocations.aspx?statename=IA

Parent and Educator Connection http://www.heartlandaea.org/instructional-services/special-education/special-education-services/parent--educator-connection-pec/

Jan Mackey

Des Moines Schools
515-242-7556

Links:

I Have a Plan https://secure.ihaveaplaniowa.gov/

Transition Assessment http://transitionassessment.northcentralrrc.org/

Transition Guide 2012 http://cyconcepts.org/wp-content/uploads/2010/07/PEC-Transition-Resource-Guide_psw2.pdf

Additional Notes:

Enter dates of review 8th grade 9th grade 10th grade 11th grade

* Aligns with 21st Century Skills

KEY: 1 = Limited exposure or understanding

2 = Basic skills, some competence w/ support

3 = Advanced, able to perform w/ limited support

4 = Independent no support needed