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Supported Employment Referral for Services
Process *
*Anyone can initiate a referral for services. The Referral forms are available on the Special Education Online Library through the AISD web or at each High School.
Referral Received & Entered by Support Staff
Assignments are made by the Supported Employment Supervisor dependent on individual student needs. Priority status will be given to graduating seniors that meet the referral guidelines. Students not immediately assigned an Employment Consultant will go on the SE Referral Waiting List.
Call Supervisor or Support Call Teacher to Arrange Staff to Check Availability Employment Planning for Employment Planning Meeting. Meeting.
EMPLOYMENT PLANNING MEETING
• Student Identifies Preferences, Contributions and Conditions for Employment
• Develop an Action Plan • Provide Person Centered Planning Information
SE Austin 2005-1011R 1 of 2
DEVELOPED by AISD EMPLOYMENT CONSULTANTS
Employment Process Begins
Communication
with Teacher & Student
FOLLOW UP MEETINGS- Every 6 wks. as needed
(Date, time & place pre-arranged at initial Employment Planning Meeting)
• Report on action plan • Discuss job development progress
• Make a new action plan Communication with Teacher & Student
Continue Employment Process
If Employment is Secured:
. EMPLOYMENT SECURED
• Contact Teacher To Schedule ARD To Change Class Schedule/Identify IEP Objectives (Maximum 2 weeks after Employment Secured)
• Continual Feedback to Student, Teacher, Parents & • Residential Facility (if applicable) Regarding Progress • Schedule Sensitivity Training with Employer
2 of 2
Supported Employment AISD Referral Guidelines
•PRIORITY WILL BE GIVEN TO STUDENTS WHO HAVE PARTICIATED IN COMMUNITY •THE DISABILITY IS
BASED VOCATIONAL SO SIGNIFICANT
INSTRUCTION THAT EXTENSIVE
LONG TERM
SUPPORT AND/OR
MODIFICATIONS
•PRIORITY WILL BE GIVEN ARE NEEDED
TO GRADUATING SENIORS
18-21
WORK EXPERIENCE
AGE
DISABILITY
Acceptable Outcomes as the result of
Supported Employment:
• Increased self-esteem
• Development of relationships with other people.
• Exercise of choice.
• Development of new skills
• Participation in the community.
• Improved quality of life.
• Wages and economic self-sufficiency.
SUPPORTED EMPLOYMENT IS NOT AN OUTCOME
Referral for Supported Employment Services can be initiated by anyone by obtaining a Referral for Services Form, Completing Section I & Returning It To The Folder Teacher
Folder Teacher:
Send out Parent/*Guardian Questionnaire
*Can be filled out by Adult Student Maintaining Guardianship Send out Group Home or Residential Facility Questionnaire
(if applicable)
After receiving permission for services:
Complete Section II of Referral
Complete & Attach Required Documents:
Write Resume
Copy All Referral Documents for Teacher File
Send Referral to: Diana Jimenez/Rosedale/414-4960 E-mail:[email protected]
SE Austin ISD2007-000
Forward to: S.E. Austin ISD – Diana Jimenez @ Clifton 414-4960
Supported Employment Austin I.S.D. Referral for Services
Section I Student Name: ______________________________ Date: __________
Address: _________________________ Zip Code ______ Phone: __________ Parent Name: __________+____________________________ School: _____________________Folder Teacher: ______________________ Referred By: ______________________ Phone: ____________ Reason for Referral: ______________________________________________ Return to Folder Teacher for Section II completion
Section II (Completed by Student’s Folder Teacher) STUDENT INFORMATION D.O.B. _____________________ D.P.S. ID#___________________________ Has No ID
Student I.D. #____________________ Social Security #_______________________ DARS Referral Date: _______________ DARS Counselor’s Name: _____________________________________
Expected Date Of Graduation ________ MHMR Ser. Coordinator Name: ____________________________ Year Student Reaches Age 22 _________ List Any Other Outside Agency Referrals: _______________________________________________________
*FUNDING SOURCE: Post-graduate funding source must be available for students requiring
extensive on-going Supported Employment services (i.e. DARS, MHMR, CLASS, HCS, Private Pay) *DOES THE STUDENT MEET CRITERIA? Work Experience Age Disability (See S.E. AISD Referral Criteria Page Included in Packet) REQUIRED DOCUMENTS: (Attach To Referral & Submit For Services) Parent or Guardian Questionnaire Group Home or Residential Facility Questionnaire (if applicable) Resume Copy of Social Security Card
S.E. STAFF USE ONLY: Date Rec’d: ______________
Graduating Senior VAC Notified: _____________ Priority Referral:
Waiting List ACCEPTED DELAYED RETURNED
Status: Voc. Profile Complete: ______________________
Reason: Employment Planning Mtg: _____________ Follow-up Mtg: _______________________ Employed: __________________________
SE Austin Works 2007-0001
Parent/Guardian Questionnaire 1 of 2
PARENT /*GUARDIAN QUESTIONNAIRE *Can be completed by Adult Student Maintaining Guardianship
Austin ISD Supported Employment AustinWorks
Name Of Student: _______________________________________________________________ Name Of Parent: ________________________________________________________________
Name Of Legal Guardian Or Adult Student Maintaining Guardianship: ______________________________________________________________________________ Parent Address (if different from student’s address): ______________________________________________________________________________ Parent/Guardian phone: (HM) _____________________ (WK) _________________________
• Does your son/daughter meet the following guidelines for Supported Employment? YES NO
• WORK EXPERIENCE – Priority will be given to students who have participated in
community based vocational instruction.
• AGE – Priority will be given to graduating seniors 18-21
• DISABILITY – The disability is so significant that extensive long term support and/or
modifications are needed.
If you have questions regarding the criteria, please contact your son or daughter’s teacher. Please circle your responses: • Are you interested in your son/daughter having a paid job? YES NO * (If no, please skip to page 2: sign and date document & return questionnaire to school) • How many hours a week do you think your son/daughter could work? LESS THAN 4 HRS. 4-8 HRS. 10-20 HRS. Other: ___________ • May your son/daughter work on weekends? YES NO • Are there any days during the week you would not want your son/daughter to work?
MON. TUES. WED. THURS. FRI.
• Does your son/daughter receive SSI payments? YES NO If so, are you aware that by obtaining paid employment your son/daughter’s payments
may decrease? YES NO • Area of town student lives in: NORTH SOUTH EAST WEST • Which form of public transportation will you allow your son/daughter to use to get to and from work? CAPITOL METRO SPECIAL TRANSIT GROUP HOME VAN
SHARED RIDES (with neighbors or co-workers) TAXI NONE
If not, how will your son/daughter get to and from work? ____________________ • Do you want your son/daughter to work: *NEAR HOME *NEAR SCHOOL *NEAR YOUR WORK PLACE
*THE RIGHT JOB IS MORE IMPORTANT THAN THE AREA OF TOWN
• Does your son/daughter work best: ALONE WITH A GROUP Please fill in the blanks: **INCLUDE FUNDING SOURCES** • What agency or funding source will provide support on the job after graduation? _____________________________________________________________________________ • Have you initiated contact with this agency? YES ________ NO ________
Parent/Guardian Questionnaire 2 of 2
• List any medical concerns regarding your son/daughter that might impact a work place: ______________________________________________________________________________________ ______________________________________________________________________________________ • List any medications that your son/daughter takes and the time of day it is taken: ______________________________________________________________________________________ ______________________________________________________________________________________ • What is your son/daughter’s favorite type of task/activity at school or around the house? ______________________________________________________________________________________ ______________________________________________________________________________________
• List your son/daughter’s strengths:______________________________________________________ ______________________________________________________________________________________
______________________________________________________________________________________
• What type of task/activity does your son/daughter not like to do?_____________________________
______________________________________________________________________________________ • What kind of activity does your son/daughter enjoy the most at home? ______________________________________________________________________________________
• Are there any behaviors, habits or fears that the S.E. Staff should be aware of that would assist us as we explore community and work settings with your son/daughter? (This information is needed to place the student in an appropriate work environment and will not be used to exclude a student.) ______________________________________________________________________________________ ______________________________________________________________________________________ • Please list 3 possible places of employment and the type of work skills your son/daughter would be able to offer an employer: 1. Place of employment: ___________________________________________________________
Work skill: ____________________________________________________________________
2. Place of employment: ___________________________________________________________
Work skill: ____________________________________________________________________ 3. Place of employment: __________________________________________________________
Work skill: ____________________________________________________________________
• Please feel free to provide us with additional information about your son/daughter that would be beneficial as we work with your son/daughter:
______________________________________________________________________________________
______________________________________________________________________________________
BY SIGNING THIS DOCUMENT, YOU AGREE THAT THE INFORMATION PROVIDED IS CORRECT AND ARE OF THE UNDERSTANDING THAT A.I.S.D. AUSTIN WORKS SUPPORTED EMPLOYMENT CANNOT GUARANTEE EMPLOYMENT.
WHAT WE WILL GUARANTEE IS THAT WE WILL DO OUR VERY BEST TO SECURE EMPLOYMENT.
Signature of Parent/Guardian or Adult Student Providing Information Date
SE Austin ISD 2007-0002R
GROUP HOME/RESIDENTIAL FACILITY QUESTIONNAIRE
Austin ISD Supported Employment AustinWorks
Check & Return to teacher if:
Group Home/Residential Facility Not Applicable Name of student: ___________________________________________________________
Name of parent: ____________________________________________________________ Name of legal guardian or adult student maintaining guardianship:
__________________________________________________________________________
Parent address (if different from student’s address): __________________________________________________________________________
Group Home/Residential Facility Phone: _______________________________________
Q.M.R. P. Name: ____________________________ Phone: ________________________
• Does this resident meet the following guidelines for Supported Employment? YES NO • WORK EXPERIENCE – Priority will be given to residents who have participated
in community based vocational instruction.
• AGE – Priority will be given to graduating residents 18-21 • DISABILITY – The disability is so significant that extensive long term support and/or
modifications are needed.
If you have any questions regarding the criteria, please contact the resident’s teacher.
Please circle your responses:
• Will the group home/residential facility support this resident having a paid job? YES NO
• How many hours a week will you support this resident to working?
LESS THAN 4 HRS. 4-8 HRS. 10-20 HRS. Other: ________
• May this resident work on weekends? YES NO • Are there any days during the week you do not want this resident to work?
MON. TUES. WED. THURS. FRI.
• Area of town student lives in: NORTH SOUTH EAST WEST
• Which form of public transportation will this resident use to get to and from work?
CAPITOL METRO SPECIAL TRANSIT GROUP HOME/RES. FAC. VAN
SHARED RIDES (with family, neighbors or co-workers) TAXI NONE
If not, how will this resident get to and from work? ______________
• Do you want this resident to work: *NEAR HOME *NEAR SCHOOL
*NEAR YOUR WORK PLACE
*THE RIGHT JOB IS MORE IMPORTANT THAN THE AREA OF TOWN.
• Does this resident work best: ALONE WITH A GROUP
Please fill in the blanks:
• What agency or funding source will provide the resident support on the job after
graduation? _____________________________________________________________
• Have you initiated contact with this agency? YES _________ NO ________
Group Home/Residential Facility Questionnaire p. 2 of 2
• List any medical concerns regarding this resident that might impact a work place:
___________________________________________________________________________
___________________________________________________________________________
• List any medications that this resident takes and the time of day it is taken: ___________________________________________________________________________________________
___________________________________________________________________________________________
• What is this resident’s favorite type of chores at school or around the house?
___________________________________________________________________________
___________________________________________________________________________
• List this resident’s strengths:_______________________________________________
___________________________________________________________________________
• What type of chores does this resident not like to do? __________________________
___________________________________________________________________________
• What kind of activity does this resident enjoy the most at home?
___________________________________________________________________________
• Are there any behaviors, habits or fears the resident has that would assist the S.E.
Staff as we explore community and work settings? (This information is needed to place
the student in an appropriate work environment and will not be used to exclude a student.)
____________________________________________________________________________ ____________________________________________________________________________
• Please list 3 possible places of employment and the type of work skills the resident would be able to offer an employer:
1. Place of employment: ______________________________________________________
Work skill:________________________________________________________________
2. Place of employment:_______________________________________________________
Work skill: ________________________________________________________________
3. Place of employment:_______________________________________________________
Work skill: ________________________________________________________________
• Please feel free to provide us with additional information about this resident that
would assist us in working with this student.
______________________________________________________________________ ______________________________________________________________________ BY SIGNING THIS DOCUMENT, YOU AGREE THAT THE INFORMATION PROVIDED IS CORRECT AND ARE OF THE
UNDERSTANDING THAT A.I.S.D. AUSTIN WORKS SUPPORTED EMPLOYMENT CANNOT GUARANTEE EMPLOYMENT. WHAT WE WILL GUARANTEE IS THAT WE WILL DO OUR BEST TO SECURE EMPLOYMENT.
Signature of Person Providing Information Date
S.E. Austin 2007-0003
Nombre del estudiante: __________________________________________________________________ Nombre del padre/madre: ________________________________________________________________ Nombre del custodio legal o del estudiante adulto que mantiene la custodia: _____________________ _______________________________________________________________________________________ Dirección del padre/madre (si es diferente de la del estudiante): _______________________________ _______________________________________________________________________________________ Teléfono del padre/madre/custodio legal: (casa) _________________ (trabajo) ____________________
� ¿Encuentra su hijo(a) las pautas siguientes para el Empleo Apoyado? Sí No
• EXPERIENCIA DE TRABAJO – Se le dará prioridad a los estudiantes que han participado en la instrucción vocacional comunitaria.
• EDAD – Se le dará prioridad a los estudiantes de preparatoria que tengan entre los 18 y 21 años.
• Discapacidad – La discapacidad debe de ser significativa que necesita apoyo extensivo y/o necesita modificaciones. Si usted tiene preguntas respecto a los criterios, por favor contacte al maestro de su hijo(a).
Favor de encerrar en un círculo sus respuestas:
¿Es interesado usted en su hijo(a) que tiene un trabajo pagado? SÍ NO* (Si responde no, sírvase pasar a la página 2: ponga su firma y fecha al documento y devuelva el cuestionario a la escuela.)
¿Cuántas horas en una semana piensa usted que su hijo(a) poder trabajar? MENOS DE 4 HORAS, 4 - 8 HORAS, 10 - 20 HORAS, OTRO HORARIO _________
¿Puede trabajar su hijo(a) en fines de semana? SÍ NO
¿Hay algún días de la semana en que usted no quiera que sue hijo(a) trabaje? LUNES MARTES MIÉRCOLES JUEVES VIERNES
¿Recibe su hijo(a) pagos del SSI? S NO Si los recibe, ¿sabe usted que, por tener su hijo(a) empleo pagado, es posible que sus pagos del SSI sean más bajos? S NO
Zona de la ciudad donde vive el/la estudiante: NORTE SUR ESTE OESTE
¿Qué forma de transporte público permitiría Ud. a su hijo(a) usar para ir al trabajo y regresar de él? CAPITOL METRO, TRÁNSITO ESPECIAL, CAMIONETA CASERA EN GRUPO
DE VIAJES COMPARTIDOS (con vecinos o compa eros de trabajo) TAXI, NINGUNO
Si no, ¿cómo iría su hijo(a) al trabajo o cómo regresaría de él? _______________________________
¿Desea Ud. que su hijo(a) trabaje: *CERCA DE SU CASA?
*CERCA DE LA ESCUELA?
*CERCA DEL LUGAR DONDE TRABAJA USTED?
*EL EMPLEO APROPIADO ES MÁS IMPORTANTE QUE LA ZONA
DE LA CIUDAD
¿Cómo trabaja mejor su hijo(a): SOLO(A) CON UN GRUPO?
Sírvase llenar los espacios en blanco: **INCLUYA LAS FUENTES DE LA FINANCIACIÓN**
¿Qué agencia o fuente de financiamiento proporcionará apoyo en el trabajo después de la graduación? ________________________________________________________________________
¿Ha iniciado usted el cantacto con esta agencia? S ___________ NO ____________
CUESTIONARIO PARA PADRES DE FAMILIA / CUSTODIOS LEGALES
Austin ISD Empleo Apoyado AustinWorks
Cuestionario de padres/cust. legales, pag. 2 de 2
Haga, por favor, una lista de todas las preocupaciones médicas relativas a su hijo(a) que podrían tener algúr efecto en el lugar del trabajo: ________________________________________________ _____________________________________________________________________________________
Sírvase hacer una lista de todas las medicinas que tome su hijo(a) y la hora del día en que debe tomarlas: ___________________________________________________________________________
¿Cuál es el tipo de trabajo que prefiere su hijo(a) en la escuela o en la casa?___________________ ____________________________________________________________________________________
Sírvase hacer una lista de los lados fuertes de su hijo(a): ___________________________________ ____________________________________________________________________________________
¿Qué es su tipo favorito de su hijo(a) de la tarea/actividad en la escuela or alrededor de la casa? ____________________________________________________________________________________ ____________________________________________________________________________________
¿Qué tipo de tarea/actividad no le gusta hacer su hijo(a)?____________________________________ _____________________________________________________________________________________
¿Hay cualquier conducta, hábitos o temores que el personal de Empleo Apoyado debe estar enterado de que nos ayudaría como exploramos los escenarios de la comunidad y el trabajo con su hijo? (Esta información se necesita para colocar al estudiante en un ambiente apropiado de trabajo, y no se usará para excluir a un estudiante.) __________________________________________________________________ ______________________________________________________________________________________
Sírvase mencionar 3 posibles lugares de empleo y el tipo de habilidades laborales que su hijo(a) podría ofrecer a un empresario: 1. Lugar de empleo: _____________________________________________________________________ Habilidad laboral: _____________________________________________________________________ 2. Lugar de empleo: _____________________________________________________________________ Habilidad laboral: _____________________________________________________________________ 3. Lugar de empleo: _____________________________________________________________________ Habilidad laboral: _____________________________________________________________________
Siéntase por favor libre proporcionarnos con información adicional acerca de sure hijo(a) que sería beneficiosa como trabajamos con su hijo(a): _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
Firmando este documento, usted concuerda que la información proporcionada es correcta y es de la
comprensión que Austin ISD Empleo Apoyado Austin Works no puede garantizar el empleo. Qué
nosotros garantizaremos es que haremos nuestro lo mejor para asegurar el empleo.
Firma del padre/madre/custodio legal o estudiante adulto Fecha que proporciona la información
SE Austin 2007-0004
My Resume
Your Name: ________________________________
Your Address: ______________________________
Your City & State: ___________________________
Your Phone Number: __________________________
Career Objective: _________________________________
Education: School Name: _________________________________
Diploma: _____________________________________
Date: _______________________________________
Experience: Company Name: __________________________________
Dates Employed: _______________________________________
Address: ______________________________________________
City & State: __________________________________
Contact: _____________________________________
Duties: _______________________________
Duties: _______________________________
Duties: _______________________________
Company Name: __________________________________
Dates Employed: _______________________________________
Address: ______________________________________________
City & State: __________________________________
Contact: _____________________________________
Duties: _______________________________
Duties: _______________________________
Duties: _______________________________
