youth

Individual Service Strategy(ISS)

Printed Name:______Date:______

Street Address:______City:______State:______ZIP:______

Home Phone: ______Cell Phone:______

Email:______Facebook:______

Birthdate:______Age:______Participant ID#______

IMMEDIATE NEEDS

What brought you to CareerFORCE?
What are your immediate needs?

Employment History

List your last three employers, starting with the most recent first.

Employer / From / To / Job Title / Hourly Wage / Duties, Skills

Education History

Currently in High School _____YES _____NO
If YES, Grade Level: _____
High School Name:______ / Degrees, Licenses, Certifications earned: (List each by type and Name of School)
High School Diploma/GED obtained
____YES ______NO
If NO, Highest Grade Completed _____

Interests and skills inventory

Basic Skills Inventory

Basic Skills Proficiency (Basic Skills Deficient if test at or below 8thGrade Level)

Pre-Test Level:

Name of Test:______Administered by: ______Date: ______

Level Tested At: Reading Scaled Score______Reading Grade Level _____

Math Scaled Score______Math Grade Level _____

Post-Test Level:

Name of Test: ______Administered by: ______Date: ______

Level Tested At: Reading Scaled Score______Reading Grade Level _____

Math Scaled Score______Math Grade Level _____

assessmentS of occupational skills, employability, interests and aptituDes

assessment NAME / strengths / needs

WorkKeys® required Target Occupation Level Scores must be met before youth receives Individual Training Account (ITA)

Target Occupation: / O*net SOC Code:
Required WorkKeys® Level Scores / Reading Required Score / Youth
Reading Score / Math Required Score / Youth Math Score / Locating Information Required Score / Youth Locating Information Score
LV Targeted Industry Sectors / Healthcare and Life Sciences / Business, Professional and Financial Services
Diversified Manufacturing and Services / Energy Manufacturing and Services

employment, education and personal goals

Short Term Employment Goals:
Long Term Employment Goals:
Short Term Education Goals:
Long Term Education Goals:
Short Term Personal Goals:
Long Term Personal Goals:

Complete Career pathways plan of connected long-term and short-term employment and education goals

In-school youth barriers

√ Check as Applicable

Basic Skills Deficient / Pregnant or Parenting
English Language Learner / Individual with a Disability
Offender
Homeless, Runaway, In Foster Care or Aged Out of Foster Care System, Eligible for assistance under Section 477 of the Social Security Act, or in Out-of-Home Placement

out-of-school youth barriers

√ Check as Applicable

School Dropout
Within Age of Compulsory School Attendance, but has not attended for at least most recent complete school year calendar quarter / Pregnant or Parenting
Secondary School Diploma or GED and either Basic Skills Deficient or English Language Learner and Low-Income / Individual with a Disability
Subject to Juvenile or Adult Justice System / Low-income individual who requires additional assistance to enter or complete an educational program or secure or hold employment as defined by the LVWIB
-youth of incarcerated parents
-lacks a significant work history
Homeless, Runaway, in Foster Care or Aged Out of Foster Care System, Eligible for Assistance under Section 477 of the Social Security Act, or in Out-of-Home Placement

support services assessment

(Support Services enable an individual to participate in WIOA Activities)

transportation

Do you have a current Pennsylvania Driver’s License?_____ YES_____ NO

What type of transportation do you rely on?____ Personal_____ Public _____ Other

Indicate any assistance you would need with mode of transportation:______

______

Child care

Do you have children who require child care services?_____ YES_____ NO

If yes, do you have a child care provider?_____YES_____ NO

Are you eligible to receive Title XX funding?_____YES_____ NO

If yes, are you: _____currently using Title XX funding _____on a waiting list for Title XX funding

Indicate the type of assistance that you would need with day care: ______

______

Personal/workplace needs

Do you need assistance with:

Food_____ YES_____NOInterview/Workplace Attire_____YES_____NO

Housing_____ YES_____NOWorkplace Tools/Supplies_____YES_____NO

Referrals to Health Care_____YES_____NO Other______

______

americans with disabilties act (ada) accomodations

Would you be in need of any specialized services (such as large print, hearing devices or sign interpretation) while you participate in the CareerFORCE program? _____ YES _____NO

If yes, please indicate what services you would require:______

______

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GOALS AND SERVICE PLAN
LOCAL PROGRAMS MUST MAKE EACH OF THE FOLLOWING 14 SERVICES AVAILABLE TO YOUTH PARTICIPANTS
LOCAL PROGRAMS HAVE THE DISCRETION TO DETERMINE WHAT SPECIFIC PROGRAM SERVICES A YOUTH PARTICIPANT RECEIVES BASED ON EACH PARTICIPANT’S OBJECTIVE ASSESSMENT AND INDIVIDUAL SERVICE STRATEGY
Indicate the goal(s) and describe the service interventions to be taken, including any level of participant involvement, towards achieving the goal(s).
Tutoring
Tutoring, study skills training, instruction and evidence-based dropout prevention and recovery strategies that lead to completion of the requirements for a secondary school diploma or its recognized equivalent (including a recognized certificate of attendance or similar document for individuals with disabilities) or for a recognized post-secondary credential
Provider: Start Date: End Date: Completed: YES____ NO____
Goal(s):
Schedule of Activities/Responsibilities:
Participant Signature/Date:
Staff Signature/Date:
Alternative Secondary School Services
Alternative secondary school services, or dropout recovery services as appropriate
Provider: Start Date: End Date: Completed: YES____ NO____
Goal(s):
Schedule of Activities/Responsibilities:
Participant Signature/Date:
Staff Signature/Date:
paid and unpaid work experiences
Paid and unpaid work experiences that have academic and occupational education as a component of the work experience, which may include the following types of work experience: summer employment opportunities and other employment opportunities available throughout the school year; pre-apprenticeship programs; internships and job shadowing; and on-the-job training opportunities
Provider: Start Date: End Date: Completed: YES____ NO____
Goal(s):
Schedule of Activities/Responsibilities:
Participant Signature/Date:
Staff Signature/Date:
Occupational Skill Training
Occupational skill training, which includes priority consideration for training programs that lead to recognized post-secondary credentials that align with in demand industry sectors or occupations in the local area involved
Provider: Start Date: End Date: Completed: YES____ NO____
Goal(s):
Schedule of Activities/Responsibilities:
Participant Signature/Date:
Staff Signature/Date:
Education/Workforce Preparation
Education offered concurrently with and in the same context as workforce preparation activities and training for a specific occupation or occupational cluster
Provider: Start Date: End Date: Completed: YES____ NO____
Goal(s):
Schedule of Activities/Responsibilities:
Participant Signature/Date:
Staff Signature/Date:
Leadership Development Opportunities
Leadership development opportunities including community service and peer-centered activities encouraging responsibility and other positive social and civic behaviors
Provider: Start Date: End Date: Completed: YES____ NO____
Goal(s):
Schedule of Activities/Responsibilities:
Participant Signature/Date:
Staff Signature/Date:
Supportive Services
Support services which enable an individual to participate in WIOA Activities
Provider: Start Date: End Date: Completed: YES____ NO____
Goal(s):
Schedule of Activities/Responsibilities:
Participant Signature/Date:
Staff Signature/Date:
Adult Mentoring
Adult mentoring for a duration of at least twelve months, that may occur both during and after program participation
Provider: Start Date: End Date: Completed: YES____ NO____
Goal(s):
Schedule of Activities/Responsibilities:
Participant Signature/Date:
Staff Signature/Date:
Follow-Up Services
Follow-up services for not less than 12 months after completion of participation
Provider: Start Date: End Date: Completed: YES____ NO____
Goal(s):
Schedule of Activities/Responsibilities:
Participant Signature/Date:
Staff Signature/Date:
Comprehensive Guidance and Counseling
Comprehensive guidance and counseling, which may include drug and alcohol abuse counseling, as well as referrals to counseling, as appropriate to the individual youth
Provider: Start Date: End Date: Completed: YES____ NO____
Goal(s):
Schedule of Activities/Responsibilities:
Participant Signature/Date:
Staff Signature/Date
Financial literacy education
Provider: Start Date: End Date: Completed: YES____ NO____
Goal(s):
Schedule of Activities/Responsibilities:
Participant Signature/Date:
Staff Signature/Date:
Entrepreneurial Skills Training
Provider: Start Date: End Date: Completed: YES____ NO____
Goal(s):
Schedule of Activities/Responsibilities:
Participant Signature/Date:
Staff Signature/Date:
Labor Market and Employment Information
Services that provide labor market employment information about in demand industry sectors or occupations available in the local area, such as career awareness, career counseling, and career exploration services
Provider: Start Date: End Date: Completed: YES____ NO____
Goal(s):
Schedule of Activities/Responsibilities:
Participant Signature/Date:
Staff Signature/Date:
Transition Activities
Activities that help youth prepare for and transition to post-secondary education or training
Provider: Start Date: End Date: Completed: YES____ NO____
Goal(s):
Schedule of Activities/Responsibilities:
Participant Signature/Date:
Staff Signature/Date:

Revised 11-18-15Page 1 of 12

post-program follow up

Date of Exit: ______

Follow Up Service / Staff/Date / Comments
Leadership Development
Supportive Services Activities
Regular contact with youth participant’s employer, including assistance in addressing work-related problems that arise
Assistance in securing better paying jobs, career pathway development and further education or training
Work-related peer support groups
Adult mentoring
Services necessary to ensure the success of youth participants in employment and/or post-secondary education

Follow Up Case Notes:

Date / Notes

This Individual Service Strategy is a mutual agreement developed to assist you in securing employment. Full participation in Workforce Innovation and Opportunity Act (WIOA) services requires a sincere commitment on your part. This will mean maintaining contact with your Case Manager and working closely with CareerFORCE staff during the implementation and modifications of your plan.

Participant Signature______Date: ______

Staff Signature ______Date: ______

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