Parent/Guardian Name(s)
List any special services the student is currently receiving at school(therapies, counseling etc.)
Attendance/Days Absent (previous year absences/tardies)
Attendance/Days Absent (current year to date)
Please explain any excessive absences.
Date of Social Graduation: please specify actual or anticipated.
Have you met with the family and do they understand social graduation and the holding of their high school diploma?
Expected date of exit from school
What are the students interests, both personal and work related?
What are the student's strengths?
What are the student’s challenges?
What supports are most important to assist this student in being successful?
Does the student currently receive any supports for restroom, lunch or similar needs?
Are there any behaviors that will impact a successful job placement? If YES, please explain:
Are the parents/guardians actively involved in student’s educational program and attend IEP meetings?
What is the best way to contact this family?
Describe the student's peer relationships.
Describe the student's relationships with supervisors and teachers.
Does the individual understand boundaries? Explain any boundary issues.
How often does the student’s stress level interfere with his/her performance? Please be specific.
What factors cause this student to "shut down"?
Does this student have signal that may indicate that a potential “meltdown” may occur? What interventions are needed to prevent a "meltdown"? Please be specific.
How do you believe this student will benefit from placement in Project SEARCH?
Are there any major life events we should be aware of in regards to this particular student?
