Independent Living Services Checklist (Optional), CFS-2251
DEPARTMENT OF CHILDREN AND FAMILIESDivision of Safety and PermanenceINDEPENDENT LIVING SERVICES CHECKLIST (OPTIONAL)Name – Participant: FORMTEXT ?????SKILL AREASPOTENTIAL ACTION PLANWITH SUGGESTED ACTIVITIES AND TOOLSNOTESEDUCATIONAL PLANNING FORMTEXT ?????High School Completion FORMCHECKBOX Develop plan to finish high school: FORMCHECKBOX Diploma FORMCHECKBOX HSED FORMCHECKBOX Other: FORMTEXT ?????Post High School Planning FORMCHECKBOX Explore and choose post high school option: FORMCHECKBOX GED / HSED FORMCHECKBOX Technical school FORMCHECKBOX Apprenticeship FORMCHECKBOX Job Corp FORMCHECKBOX Military FORMCHECKBOX College FORMCHECKBOX Other: FORMTEXT ?????Applications FORMCHECKBOX Fill out applications FORMCHECKBOX Submit applicationsFinancial Aid Resources FORMCHECKBOX Identify and apply for various: FORMCHECKBOX Grants FORMCHECKBOX Loans FORMCHECKBOX Scholarships FORMCHECKBOX Visit / tour school you plan to attend FORMCHECKBOX Other: FORMTEXT ?????CAREER EXPLORATION FORMCHECKBOX Gather information about specific jobs / careers FORMTEXT ????? FORMTEXT FORMCHECKBOX Complete a career interest inventory through high school or MATC FORMCHECKBOX Conduct informational interviews with adults working in three careers of interest FORMCHECKBOX Arrange to job shadow adults in jobs / careers of interest FORMCHECKBOX Other: FORMTEXT ?????DOCUMENTS FORMTEXT ????? FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT Personal Identification FORMCHECKBOX Obtain and gather important documents for adulthood: FORMCHECKBOX Birth certificate FORMCHECKBOX Social security card FORMCHECKBOX Driver's license FORMCHECKBOX ID card FORMCHECKBOX Medical card FORMCHECKBOX Medical records FORMCHECKBOX High school or GED diploma FORMCHECKBOX School transcripts FORMCHECKBOX Work permit FORMCHECKBOX Selective service (males) FORMCHECKBOX Citizenship papers FORMCHECKBOX Death certificateWho Am I? FORMCHECKBOX Life book FORMCHECKBOX Other documents: FORMTEXT ????? FORMTEXT ?????EMPLOYMENT FORMTEXT ????? FORMTEXT FORMTEXT FORMTEXT Job Seeking Skills FORMCHECKBOX Explore positive work values and qualities employers look for FORMCHECKBOX Identify various job seeking methods FORMCHECKBOX Use various job seeking methods FORMCHECKBOX Job center: register on job net FORMCHECKBOX Gather information to complete job applications (personal data sheet)DCF-F-CFS2251-E (R. 04/2010)SKILL AREASPOTENTIAL ACTION PLANWITH SUGGESTED ACTIVITIES AND TOOLSNOTESEMPLOYMENT (cont.) FORMCHECKBOX Thoroughly and accurately complete job applications FORMTEXT ????? FORMTEXT Job Seeking Skills (cont.) FORMCHECKBOX Practice and conduct telephone inquiries about job openings (cold calls) FORMCHECKBOX Create a resume FORMCHECKBOX Discuss how to prepare for a job interview FORMCHECKBOX Role play mock interviews FORMCHECKBOX Attend "real" interviews FORMCHECKBOX Explore discriminatory interview questions FORMCHECKBOX Obtain employment FORMCHECKBOX Work schedule FORMCHECKBOX TransportationEmployment FORMCHECKBOX Understand forms related to taxes; e.g., 1040EZ, W-2, W-4 FORMCHECKBOX Complete and file tax return by required date FORMCHECKBOX Understand pay stub deductions: FORMCHECKBOX Gross vs. net pay FORMCHECKBOX State / federal taxes FORMCHECKBOX FICA FORMCHECKBOX Learn about fringe benefits FORMCHECKBOX Discuss interpersonal skills needed to maintain employment FORMCHECKBOX Practice positive work relations with: FORMCHECKBOX Customers FORMCHECKBOX Coworkers FORMCHECKBOX Boss FORMCHECKBOX Role play job related problems using: FORMCHECKBOX Conflict resolution FORMCHECKBOX Assertiveness skills FORMCHECKBOX Learn how to terminate employment appropriately FORMCHECKBOX Learn how to identify harassment or discrimination on the job FORMCHECKBOX Learn how to file a complaint with the Equal Rights DivisionMONEY MANAGEMENT FORMCHECKBOX Record income / expenses for one month FORMTEXT ????? FORMCHECKBOX Identify costs of transition to independent living (furnishings, rent, security deposit, other living expenses) FORMCHECKBOX Develop savings plan (long and short term) FORMCHECKBOX Develop monthly budget FORMCHECKBOX Obtain: FORMCHECKBOX Savings account FORMCHECKBOX Checking account FORMCHECKBOX Money orders FORMCHECKBOX Bank and checking account exercises (check writing, balance checkbook, loans) FORMCHECKBOX Budgeting simulationCONSUMER AWARENESS FORMTEXT ?????Impact of Advertising FORMCHECKBOX Discuss / make collage on effects of magazine / television adsMoney Saving Strategies FORMCHECKBOX Utilize comparison shopping strategies: FORMCHECKBOX Shop for sales (calculate percent off) FORMCHECKBOX Generic vs. name brand FORMCHECKBOX Wholesale vs. retail FORMCHECKBOX Consumer Reports magazine FORMCHECKBOX Explore and utilize tips for saving money while grocery shopping: FORMCHECKBOX Coupons FORMCHECKBOX Unit price comparison FORMCHECKBOX Sales FORMCHECKBOX Eating out vs. preparing food FORMCHECKBOX Research various fraudulent scams that may impact you as a consumer; i.e., vacation, employment, car repairLegal Regulations to Protect Consumers FORMCHECKBOX Identify laws that protect consumers: FORMCHECKBOX Three day right to cancel FORMCHECKBOX Car repair FORMCHECKBOX Lemon law FORMCHECKBOX Telephone telemarketers2SKILL AREASPOTENTIAL ACTION PLANWITH SUGGESTED ACTIVITIES AND TOOLSNOTESCONSUMER AWARENESS(cont.) FORMCHECKBOX Analyze a sweepstakes offer you receive in the mail FORMTEXT ????? FORMCHECKBOX Department of Consumer Protection Agency:Legal Regulations to Protect Consumers (cont.) FORMCHECKBOX Explore how they help consumers FORMCHECKBOX Learn the process for filing complaints FORMCHECKBOX Other: FORMTEXT ?????Credit FORMCHECKBOX How to establish credit FORMCHECKBOX How to access credit rating FORMCHECKBOX Advantages of using credit cards FORMCHECKBOX Disadvantages to using credit cardsLEGAL FORMTEXT ?????Delinquency Status FORMCHECKBOX Review current legal record (charges, fines, restitution)Adult Criminal Justice FORMCHECKBOX Learn rights of arrest (Miranda) FORMCHECKBOX Learn differences between misdemeanor, felony, and violation FORMCHECKBOX Learn legal penalties for various crimes charged as an adult FORMCHECKBOX Learn how to access affordable legal counselAdult Rights andResponsibilities FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Learn rights of being an adult ("On Being 18" book)Learn how to register for selective serviceVoting - Learn: FORMCHECKBOX How to register FORMCHECKBOX Where to vote FORMCHECKBOX Learn how to contact elected governmental representatives FORMCHECKBOX Understand consequences of signing a legal contract FORMCHECKBOX Learn responsibilities of jury duty FORMCHECKBOX Other: FORMTEXT ?????GETTING AROUND FORMTEXT ?????Transportation Options FORMCHECKBOX Develop transportation plan: Needs vs. wantsand Resources FORMCHECKBOX Learn how to read: FORMCHECKBOX City map FORMCHECKBOX State map FORMCHECKBOX Bus schedule FORMCHECKBOX Obtain: FORMCHECKBOX Bus pass FORMCHECKBOX Driver's permit FORMCHECKBOX Driver's license FORMCHECKBOX Car poolVehicle Ownership FORMCHECKBOX Learn how to shop for first vehicle FORMCHECKBOX Write down realistic costs of vehicle ownership; vehicle payments, maintenance, repairs, gas, license, insurance, etc. FORMCHECKBOX Explore types of vehicle insurance; e.g. collision, liability, etc. FORMCHECKBOX Discuss ongoing upkeep / maintenance on vehicle FORMCHECKBOX Other: FORMTEXT ?????RECREATION AND COMMUNITYINVOLVEMENT FORMTEXT ?????Personal Interests FORMCHECKBOX Examine current friendships and expanding / changing friends FORMCHECKBOX Identify current and new areas of interest (hobbies, sports, etc.) FORMCHECKBOX Get involved in a hobby or organizations reflecting interestsLeadership FORMCHECKBOX Participate in youth leadership activities: FORMCHECKBOX Trainings FORMCHECKBOX Conference FORMCHECKBOX Youth boards FORMCHECKBOX Independent living groups FORMCHECKBOX Camp counselor FORMCHECKBOX Safe Night FORMCHECKBOX Other: FORMTEXT ?????Community Activities FORMCHECKBOX Volunteer in an activity that helps your community FORMCHECKBOX Identify community activities and level of interest FORMCHECKBOX Other: FORMTEXT ?????3SKILL AREASPOTENTIAL ACTION PLANWITH SUGGESTED ACTIVITIES AND TOOLSNOTESPERSONAL SUPPORT ANDCOMMUNITY RESOURCES FORMTEXT ?????Personal Support Networks FORMCHECKBOX Identify and assess current personal support system (self, eco-maps) FORMCHECKBOX Identify and develop personal support system for adulthoodCommunity Resources FORMCHECKBOX Learn about various community resources and how to access FORMCHECKBOX Learn how to use the telephone book to locate services FORMCHECKBOX List and visit resources you will use as an adult (scavenger hunt)VALUES AND INTERPERSONAL SKILLS FORMCHECKBOX Identify values and impact of values on decisions and outcomes FORMTEXT ????? FORMCHECKBOX Identify situations that may have negative impact on future (alcohol / other drug use, poor job skills, criminal record, early pregnancy, poor choices, relationships, etc.) FORMCHECKBOX Identify alternative choices FORMCHECKBOX Identify current style of making decisions / problem solving / dealing with conflict FORMCHECKBOX Identify current problems / conflicts and how they are being resolved FORMCHECKBOX Identify and role play new strategies for above. Use tools if helpful (SODAS, satellite decisions) FORMCHECKBOX Identify and plan towards long and short term measurable goals FORMCHECKBOX Identify current emotional coping strategies FORMCHECKBOX Identify and practice new emotional coping strategies FORMCHECKBOX Identify and practice ways to develop positive self-esteem FORMCHECKBOX Identify and practice stress management techniques FORMCHECKBOX Identify and practice ways to deal with anger FORMCHECKBOX Identify and practice appropriate social skills for a variety of situations FORMCHECKBOX Identify and practice messages that body language conveys FORMCHECKBOX Identify and practice assertive communication skills FORMCHECKBOX Identify and practice time management techniquesHEALTH AND HYGIENE FORMTEXT ?????Medical Needs and Issues FORMCHECKBOX Gather health history information FORMCHECKBOX Identify current medical needs: FORMCHECKBOX Physical FORMCHECKBOX Dental FORMCHECKBOX Vision FORMCHECKBOX Medications FORMCHECKBOX Therapy FORMCHECKBOX Mental; e.g., depression and / or abuse issues FORMCHECKBOX AODA FORMCHECKBOX Identify plan for how above medical and mental health needs will be taken care of in adulthood FORMCHECKBOX Visit community health care clinic; explore low cost health care FORMCHECKBOX Call to make medical appointments: FORMCHECKBOX Obtain prescriptions FORMCHECKBOX Investigate the appropriate use of visits to: FORMCHECKBOX Doctor's office FORMCHECKBOX Emergency room FORMCHECKBOX Urgent care facility FORMCHECKBOX 911Health Insurance FORMCHECKBOX Explore options for medical insurance (include BadgerCare)Preventive Health FORMCHECKBOX Identify plan to stay healthy (diet, exercise, yearly doctor and dentist visits, etc.) FORMCHECKBOX Learn how to care for self when ill (cold, flu, sore throat, fever): FORMCHECKBOX Take a temperature FORMCHECKBOX Over-the-counter medicationsFirst Aid FORMCHECKBOX Learn various first aid methodsHygiene FORMCHECKBOX Practice good personal hygiene4SKILL AREASPOTENTIAL ACTION PLANWITH SUGGESTED ACTIVITIES AND TOOLSNOTESRELATIONSHIPS FORMCHECKBOX Discuss values regarding abstinence and sexual decisions FORMTEXT ????? FORMCHECKBOX Explore sexual orientation / identity FORMCHECKBOX Identify issues facing young adult relationships and strategies to overcome FORMCHECKBOX Identify and discuss avoiding and / or getting out of abusive relationships FORMCHECKBOX Learn about current birth control options FORMCHECKBOX Uses current options in birth control FORMCHECKBOX Effective use of condoms FORMCHECKBOX Practices safe use of condoms to prevent STI's FORMCHECKBOX Learn about STI's: FORMCHECKBOX Symptoms FORMCHECKBOX Treatment FORMCHECKBOX Prevention FORMCHECKBOX Learn and practice positive parenting skills: FORMCHECKBOX Family enhancement FORMCHECKBOX Support group FORMCHECKBOX Mentor FORMCHECKBOX Urban League Teen Parenting Program FORMCHECKBOX Other: FORMTEXT ?????HOUSING FORMCHECKBOX Identify factors important to consider when renting an apartment FORMTEXT ????? FORMCHECKBOX Explore housing options (apartment, room, co-op) FORMCHECKBOX Call about two apartments FORMCHECKBOX Visit two apartments FORMCHECKBOX Do household furnishings inventory / wish list FORMCHECKBOX Obtain affordable furnishings FORMCHECKBOX Start-up kit FORMCHECKBOX Learn about: FORMCHECKBOX Lease FORMCHECKBOX Application terms FORMCHECKBOX Security deposit FORMCHECKBOX Check-in / check-out forms FORMCHECKBOX Sublet / sublease FORMCHECKBOX Complete housing application FORMCHECKBOX Review / sign lease FORMCHECKBOX Learn how to turn on utilitiesTenant Rights and Responsibilities FORMCHECKBOX Visit tenant resource center FORMCHECKBOX Learn about tenant / landlord rights and responsibilities FORMCHECKBOX Learn how to identify and report housing discrimination with consumer protection agencyRoommates FORMCHECKBOX Identify qualities desired in a roommate FORMCHECKBOX Interview potential roommate (roommate questionnaire) FORMCHECKBOX Develop and sign a roommate agreement FORMCHECKBOX Role play roommate conflict resolutionInsurance FORMCHECKBOX Learn about renter's insurance and costs FORMCHECKBOX Other: FORMTEXT ?????FOOD MANAGEMENT FORMTEXT ?????Nutrition FORMCHECKBOX Identify own eating habits FORMCHECKBOX Learn about food pyramid, nutrients, and healthy eating habits FORMCHECKBOX Practice healthy eating habitsMeal Planning FORMCHECKBOX Plan menu for one week using food pyramid guidelines; breakfast, lunch, dinner / supper FORMCHECKBOX Create cookbook of favorite recipes FORMCHECKBOX Make grocery list and shop for ingredients using unit price comparisons. Use budget guidelines.Food Handling, Storage / Spoilage FORMCHECKBOX Practice safe food handling techniques; proper refrigeration of leftovers, thawing, handling raw meats, sanitation FORMCHECKBOX Identify signs of food spoilage: FORMCHECKBOX Check expiration datesMeal Preparation FORMCHECKBOX Prepare one meal per week for others5SKILL AREASPOTENTIAL ACTION PLANWITH SUGGESTED ACTIVITIES AND TOOLSNOTESHOME MANAGEMENT FORMCHECKBOX Keep room clean, make bed FORMTEXT ????? FORMCHECKBOX Do chores to keep home clean FORMCHECKBOX Do laundry FORMCHECKBOX Practice how to: FORMCHECKBOX Test smoke detector / change battery FORMCHECKBOX Reset circuit breaker or change fuse FORMCHECKBOX Unclog toilet: FORMCHECKBOX Stop toilet from running FORMCHECKBOX Change light bulb FORMCHECKBOX Use a vacuum: FORMCHECKBOX Change a vacuum bag FORMCHECKBOX Other simple home repairs FORMCHECKBOX Use cleaning products for various jobs FORMCHECKBOX Other: FORMTEXT ?????EMERGENCY AND SAFETY SKILLS FORMTEXT ?????Emergency Situations FORMCHECKBOX Identify various emergency situations and how to respond: FORMCHECKBOX Poisoning FORMCHECKBOX Gas leak FORMCHECKBOX Fire FORMCHECKBOX Car accident FORMCHECKBOX Medical emergency FORMCHECKBOX Rape FORMCHECKBOX Identify community resources to deal with various emergenciesStreet and Personal Safety FORMCHECKBOX Identify potential personal safety concerns (street violence, date rape, sexual / physical abuse) FORMCHECKBOX Practice strategies to stay safe: FORMCHECKBOX Personal safety awareness FORMCHECKBOX Self-defense techniques FORMCHECKBOX Home safety (stop mail and paper, lights on timers, etc. when away) FORMCHECKBOX Check smoke detector batteryHazardous Materials FORMCHECKBOX Discuss proper usage, storage and disposal of hazardous materials: FORMCHECKBOX Household cleaners FORMCHECKBOX Used oil / gasoline FORMCHECKBOX Antifreeze FORMCHECKBOX Paint thinner FORMCHECKBOX Varnish FORMCHECKBOX Paint FORMCHECKBOX Prescription drugsFire Extinguisher FORMCHECKBOX Discuss proper use of fire extinguisher to put out fire FORMCHECKBOX Other: FORMTEXT ?????6 ................
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