Transition to Independent Living and Education

TRANSITION TO INDEPENDENT LIVING AND EDUCATION

T.I.L.E.

ENTRANCE REQUIREMENTS

Age 18 with a high school diploma OR age 22 with a certificate of completion

Be a Central Valley Regional Center client

Student must be willing to commit to the 2-year program which meets daily 9am-3pm. 95% attendance is required.

Student must have the motivation and desire to become more independent in their living environment or move out.

Who we cannot accept:

Students who need a personal attendant for the classroom

Students who have a history of maladaptive behavior which has or can affect them in the school setting (any sexual acting out, indecent exposure, verbal/physical aggression, self-injurious behavior, eloping, and opposition defiance).

Students with uncontrolled seizures (due to the many of locations we are in during the week, cafeteria and PE)

Students with physical and verbal aggression history in a school setting

Transition to Independent Living and Education Program T.I.L.E.

STEPS:

1.Schedule a tour for student, family member/guardian and CVRC case manager.

2.If the student is interested, CVRC case manager submits a referral packet (IPP, updated face sheet, CDER).

3.Family submits: TILE application, latest IEP and psychological from the school.

4.T.I.LE. staff reviews both packets and decides whether or not to interview the student. The student will receive a notification letter with T.I.L.E.’s decision.

5.Student interview is scheduled with student, family member/guardian, TILE counselor- Karan Dhillon and instructor/coordinator- Kathleen Moroney.

6.T.I.L.E. staff accept or deny the student. Student is notified by mail.

7.If the student is accepted, family must submit the physical examination and TB test.

8.A start date and transportation plan is finalized.

9.Student will have program orientation on the first day.

Transition to Independent Living and Education Program T.I.L.E.

Program Capacity:

We are able to enroll a total of 25 students in the program. Once the program reaches capacity we will begin a waiting list.

The waiting list process will be as follows: it will be first come, first served. Therefore the tour, interview and ALL documents must be received and the student should be ready to start. When openings occur or are anticipated to occur, the persons on the waiting list will be notified ASAP.

If the client has already started another program and has to give a 30-day notice in order to change programs, the spot will be saved for them for 30 days only. If the client is unable to start the program in 30 days, the next client on the waiting list will be contacted.

Transition to Independent Living and Education Program

(T.I.L.E.)

APPLICATION

Applicant responsibility:

Applicant and family complete the attached packet

Copy of most recent IEP and psychological from the school

Copy of Physical exam (after the interview)

Copy of TB test done within the year (after the interview)

List of best number and times to meet with careprovider______am/pm

CVRC CPC responsibility:

Referral packet: updated face sheet, IPP, CDER

Anticipated start date______

Transportation plan______

==Referral packet and application only needs to be completed if the client has toured and is interested in applying to T.I.L.E.==

 NOTE: Admission to the program is first come first served. Each party must do their part and submit documents to Karan Dhillon at the DSP&S office by dropping off, email: or fax 559-499-6038

CALIFORNIA COMMUNITY COLLEGES

DISABLED APPLICANTS PROGRAMS AND SERVICES

CONSENT FOR RELEASE OF INFORMATION

Name:
Date of birth:
Social Security :
Maiden name or any other names used:

I, the undersigned, consent to, and request all appropriate persons and/or agencies or institutions to release information regarding myself to FRESNO CITY COLLEGE for use in educational and vocational planning. All information will be will be kept confidential and maintained as part of my records with the DSP&S Office at the college. I authorize the release to include one or more of the following:

Verification of Disability

Psychological testing and evaluation results

Learning Disability Assessments

Audiology and speech/language pathology reports

Vocational Rehabilitation plan

History of aggression or other behaviors

Prescribed medications and dosage

Educational records, including progress made

CVRC document: IPP, CDER, diagnostic, face sheet

Other:______

I further give permission for the DSP&S certified professional to discuss my educational situation with other professional who have a legitimate educational need to know.

This authorization shall remain in effect until revoked in writing by the applicant.

______

Signature of applicant date

______

Signature of witness/conservator/guardian date

FRESNO CITY COLLEGE TRANSITION TO INDEPENDENT LIVING AND EDUCATION PROGRAM – TILE APPLICATION

(to be completed by the student and family/provider)

Directions: please answer each question below. Incomplete applications will not be processed.

STUDENT INFORMATION:

Name:
Address:
City
State / zip code
Phone number
email address
Social Security Number:
Gender:  Male  Female
Parent/Guardians Name(s)
Address:
City
State / zip code
Phone number
email address
CVRC counselor name:
Address:
City State / zip code
Phone number email address

EDUCATION HISTORY:

Name of last school attended:
Graduated? Yes/no. Diploma/Certificate Year
ATP programs attended:
List all Adult Day Programs attended:
Reason for changing/leaving Adult Day Program:
MEDICAL/SOCIAL/PSYCHOLOGICAL HISTORY:
List any medications you are taking (with dosage and frequency and condition)
Do you see a psychiatrist or psychologist? If so, please list the name and how long you have been going
Do you have any medical or mental health condition which affects you in school? If so, please list
Have you been hospitalized in the last 5 years? If so, what condition were you hospitalized for, when and for how long?
Have you ever hurt yourself or others?
Have you ever been arrested? If so, when and for what

FRESNO CITY COLLEGE TRANSITION TO INDEPENDENT LIVING AND EDUCATION PROGRAM –

TILE

APPLICATION

(to be completed by the family/provider)

PARENT/GUARDIAN/CAREGIVER QUESTIONAIRE:

1.What would you say are the applicant’s strengths: cooperative  responsible  follows through

attitude_______other_______other______

2.What are areas you feel that the applicant needs to improve? behavior______ attitude

cooperation being redirected  hygiene  other:______ other:______

3.Does the applicant have good hygiene, i.e. bathing, brushing teeth, dressing appropriately, grooming? If not, which area do you feel he/she needs either reminders or hands on help?  bathing  hygiene  dressing  toileting  feeding

4.Does the applicant know who his/her doctor is?  yes  no

5.Does the applicant know what medications he/she takes?  yes  no

6.If he/she takes medications, does he/she know what the medications are for?  yes  no

7.Can the applicant cook?  yes  no

8.If yes, what can he/she cook or prepare?

9.Can the applicant use a microwave?  yes  no

10.Can the applicant use a stove?  yes  no

11.Can the applicant use an oven?  yes  no

12.Do you think the applicant knows about kitchen safety?  yes  no

13.If not, which areas do you think he/she needs more help?

14.Does the applicant know the difference between a healthy meal and an unhealthy meal?  yes  no

15.Does the applicant know how to read food labels? i.e. how many calories a food has?  yes  no

16.Has or does the applicant have a boyfriend or girlfriend?  yes  no

17.Does the applicant understand the difference between a healthy relationship and unhealthy relationship?  yes  no

18.Has the applicant had sex education?  yes  no

19.Does the applicant understand the concept of safe sex?  yes  no

20.Does the applicant know what sexually transmitted diseases are?  yes  no

21.Does applicant know how to prevent sexually transmitted diseases?  yes  no

22.Does he/she know how to recognize unsafe situations?  yes  no

23.Does he/she know how to get help if they feel unsafe?  yes  no 24.Does the applicant have good verbal communication skills?  yes  no

25.How does the applicant act in social situations?

26.Does the applicant understand social cues (how to act socially)?

27.Does the applicant know how to develop and maintain friendships?  yes  no

28.Does the applicant recognize change? i.e. penny, quarter, nickel, dime?  yes  no

29.Does the applicant know the difference between paper money? i.e. dollar, five, ten, twenty etc…

 yes  no

30.Does the applicant know how to do simple purchase? i.e. paying for a meal at a fast food restaurant or buying small grocery items?  yes  no

31.Does the applicant have safety skills?  yes  no

32.Does he/she understand how much change they would get back from simple purchases?  yes  no

33.Does the applicant get SSI?  yes  no

34.If he/she gets SSI, who is the payee?

35.Does the applicant understand income vs. expenses?  yes  no

36.Does the applicant know what credit is?  yes  no

37.Does the applicant have an educational goal?  yes  no

38.Does the applicant know what accommodations are needed in the school setting?  yes  no

39.Does the applicant have a career goal?  yes  no

40.Does the applicant want to move out in the future?  yes  no

41.Do you want the applicant to become more independent in the home and to be able to move out in the future?  yes  no

42.Does the applicant have any self-injurious behaviors?  Yes no. If yes, check which ones:  head banging  self-biting  scratching to the point of bleeding  PICA (eating nonfood items i.e. paper)

43.Does the applicant have tantrums which last more than 5 minutes?  Yes  no. If yes, do are you able to re-direct him/her?  Yes  no. Do you know what trigger the tantrums?  Yes  no.

If yes, what are the triggers? Being told no  Anger

Other______

44.Does the applicant have a history of aggression?  Yes  no. If yes, check all that apply:  hitting

kicking  biting  slapping  pinching  grabbing  pushing

45.Does the applicant wander or run away?  yes  no

46.Does the applicant have trouble following directions?  yes  no

47.Does the applicant have history of verbally inappropriate behavior?  Yes  no. If yes, please check all that apply:  name calling  swearing  screaming  whining  crying

48.Does the applicant have a history of inappropriate sexual behavior?  Yes  no. If yes, please explain:______

______

Revised 9/7/16