Reference Assessment Tool (1) No. of Units. Supported Employment T2018F PCPT 2 Hour(s) Monthly 9/1/14 To 12/1/14

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1 B. Personally Defined Outcomes & Services (Outcome # of ) Ray will maintain his current employment at Home Depot 3 days per week. 2 3 Planning Goal Procedure Ray will continue to do his job to the satisfaction of his supervisors and will improve the speed at which he stocks shelves. Ray will receive support to care for his personal needs while at work and during his ol s Employment Option : Currently Employed Supported Employment T208F PCPT 2 Hour(s) Monthly 9//4 2//4 Individual Supports H206ISE PCPT 5 Hour(s) 8.30 Weekly 9//4 8/30/5 commute. Ray will commute to work. Transportation T2002HI PCPT 90 Miles(s).0 Weekly 9//4 8/30/5 Employ ment First EZ Transpor t Agency * ol : s : : :. PCPT 5 min Singular DDD Contract 2. DDD ol 30 min Daily FI (Agency)

2 Employment Option 2: Pursuing Employment B. Personally Defined Outcomes & Services (Outcome # of ) Jimmy will work in a library Planning Goal Procedure Jimmy will go to to determine eligibility for employment services. Jimmy will develop a resume and a cover letter. He will also make a list of references that includes his supervisor from his previous high school library position. Jimmy volunteers at the library, learning different aspects of the day to day duties and to develop social skills. Jimmy will commute (0 miles round trip) to his volunteer position at the library. ol s Individual Supports PCPT Singular 9//4 0/5/4 Individual Supports PCPT Singular 0/6/4 2/6/4 Individual Supports H206ISE PCPT 20 Hour(s) 4.64 Weekly 2/7/4 3/7/4 Transportation A0090HI PCPT 30 Miles(s) 0.3 Weekly 2/7/4 3/7/5 Natural Natural * ol : s : : :. PCPT 5 min Singular DDD Contract 2. DDD ol 30 min Daily FI (Agency)

3 Employment Option 3: Not Pursuing Employment B. Personally Defined Outcomes & Services (Outcome # of ) Makenna will learn more about employment opportunities and job preparedness that will lead to a position of her choice. Planning Goal Procedure Makenna will discuss and learn about different types of jobs by looking at the internet and videos. She will also volunteer at the hospital to practice work-related soft skills such as appropriate attire, interpersonal interactions, arriving on time, and time management. ol s Habilitation T2020 PCPT 5 Day(s) Weekly 9//4 8/30/5 ABC Program * ol : s : : :. PCPT 5 min Singular DDD Contract 2. DDD ol 30 min Daily FI (Agency)

4 Increase Independence & Socialization B. Personally Defined Outcomes & Services (Outcome # of 2) Jill will increase her independence in order to better access her community. Planning Goal Procedure Jill will work on socialization, community awareness, personal hygiene, and proper mealtime etiquette. ol s Individual Supports H206ISE PCPT 5 Hour(s) Weekly 9//4 8/30/5 ABC * ol : s : : :. PCPT 5 min Singular DDD Contract 2. DDD ol 30 min Daily FI (Agency) Version 4. July 204 Page 4

5 B. Personally Defined Outcomes & Services (Outcome # of 2) Linda will gain cooking skills. Planning Goal Procedure Linda will take cooking classes at Culinary Capers. She will learn how to follow a recipe, measure, and prepare simple meals. She will also learn about oven temperatures and stove settings. ol s Habilitation T205C PCPT Hour(s) Weekly 9//4 //5 Culinary Capers * ol : s : : :. PCPT 5 min Singular DDD Contract 2. DDD ol 30 min Daily FI (Agency) Trips