CrossingPoints Certificate in Occupational Studies (CCOS) Admissions Supplementary Documents Packet For Fall 2019 © CrossingPoints Program at The University of Alabama, 2018 For permission to use in any way, contact Dr Kagendo Mutua at kmutua@bamaed.ua.edu Application for Participation in CrossingPoints Certificate of Occupational Studies (CCOS) Program Description: The CrossingPoints Certificate of Occupational Studies Program (CCOS) is a postsecondary nondegree certificate program for college-age students with intellectual disabilities at The University of Alabama CCOS will operate during fall and spring semesters1 Participating students will reside in a University of Alabama residence hall and take program-specific UA courses to earn their non-degree certificate The student’s expressed interests and preferences as discussed with the student during specialized advising will be considered when choosing the courses In addition, students will participate in organized recreation activities on and off campus Eligibility Criteria: Minimum Requirements -The applicant must: • Have a documented intellectual disability (per HEOA, 2008, definition); • Have received a diploma or certificate of completion or equivalent from a high school program; • Possess functional receptive and expressive communication skills; • Have a documented history of meeting behavioral and attendance expectations of past employment, training, and/or educational programs; • Have and maintain health insurance at all times while participating in the program; • Have the ability to attend to personal, hygiene, and/or medical needs independently, including medication administration, and other routine medical processes and selfcare routines • Have the ability or potential to adhere to UA’s social decorum as expressed in the UA Capstone Creed; • Meet eligibility guidelines for State agencies (such as Vocational Rehabilitation, Medicaid, Adult DD agencies, etc.); • Have a demonstrated ability to manage free time independently; • Have a demonstrated ability to self-monitor and self-manage behaviors; • Have a demonstrated desire to participate in and complete the program; and • Have the ability to participate in a personal interview Preferred • Be between 19-26 years of age at program entrance • Be one’s own legal guardian; Program Requirements: • Participate in chosen academic classes related to their long-term goals and/or preferences; • Perform basic work skills that will be needed on most job training sites; • Participate in classroom lessons and activities designed to improve student development in postsecondary transition areas such as employment preparation, community access, independent living skill development, recreation/leisure skill development; • Interact socially (when appropriate) with classmates, co-workers, and others associated with CrossingPoints and UA; and • Pay tuition, fees, costs, and other expenses associated with participating in CCOS Interview Date: TBD Application Review Start Date: TBD Application Process: Complete the application packet provided and upload into online portal CrossingPoints 111 Hillard Building Box 870232 The University of Alabama Tuscaloosa, AL 35401 205-348-3180 Students chosen for CCOS may choose to stay on campus during the summer term However, CCOS does not operate during the summer term, so such students will so with no supports from CCOS staff As such, this is only recommended for students entering their third year Parent/Guardian Transition Survey Student’s Name: _ Student’s Age: ) _ DOB: Parent/Guardian Name: _ Date: _ 1) Upon completion of this program, you would like to see your son/daughter participate in: _ Day Care/Activity Program _ Sheltered Workshop _ Competitive Part or Full-Time Employment with time-limited support _ Competitive Part or Full-Time Employment _ Attend a Community College _ Attend a 4-year College _ Other (Specify) 2) Upon completion of this program, you anticipate your son/daughter’s living situation to be: _ At home _ With relatives _ Group Home _ Supervised Apartment _ Independent Living Situation _ Other (Specify) 3) After completion of this program, you feel that your son/daughter will most likely be supported by: _ Social Security/SSI/Medical Assistance _ His or Her Own Wages _ Department of Public Welfare _ A Combination of the Above 4) After completion of this program, you feel that your son/daughter will most likely be transported by: _ Family Members _ Public Transportation _ His/Her Own Car _ Taxi _ Other (Specify) _ 5) Which of the following adult special needs service providers have you been aware of and/or contacted for information? _ United Cerebral Palsy (UCP) _ The ARC _ Ability Alliance _ Easter Seals _ Group Home Providers (e.g Volunteers of America) _ Department of Vocational Rehabilitation (Voc Rehab) 6) Which of the following services have been made available to your son/daughter as he/she progressed through school? _ Physical Therapy _ Occupational Therapy _ Speech and Language Therapy _ Sensory Services (i.e Vision, Hearing, or Service Animals) _ Assistive Technology _ Individual/Family Counseling Adapted from Kent State University and Preparing for Life – Alabama State Department of Education _ Vocational Counseling _ Other (Specify) 7) How comfortable would you be with your son/daughter living in a supported environment? _ Very Comfortable _ Moderately Comfortable _ Uncomfortable _ Very Uncomfortable 8) After completion of this program, you feel that your son/daughter will probably (check all that apply): _ Be Friends with Peers of the Other Sex _ Have a Boy/Girlfriend But No Marriage _ Get Married _ Have Children _ Have Very Little Romantic or Social Contact With the Other Sex 9) After completion of this program, you feel that your involvement with your son/daughter will: _ Pretty Much Stay the Same _ Increase Moderately _ Decrease Moderately _ Decrease Drastically 10) In what areas you feel you have been especially helpful in preparing you son/daughter for life after this program? _ Learning Self Help Skills _ Learning Safe Travel _ Preparation of Food _ Cleaning House _ Sex Education _ Drug Education _ Management of Money _ How To Shop _ How To Avoid Potentially Dangerous Situations _ Realistic Goal Setting _ How To Get Along With People _ Vocational Planning _ How To Plan Leisure Time Activities _ How To Be As Independent As Possible _ How To Contact Help If Needed _ Other _ 11) In what areas you feel your son/daughter needs additional training before completing this program? _ Learning Self Help Skills _ Learning Safe Travel _ Preparation of Food _ Cleaning House _ Sex Education _ Drug Education _ Management of Money _ How to Shop _ How To Avoid Potentially Dangerous Situations _ Realistic Goal Setting _ How To Get Along With People _ Vocational Planning _ How To Plan Leisure Time Activities _ How To Be As Independent As Possible _ How To Contact Help If Needed _ Other _ 12) After completion of this program, which of the following leisure/recreation activities would you son/daughter benefit from and enjoy? _ Fishing/Hunting _ Water Sports _ Special Olympics _ Horseback Riding _ Church Related Activities _ Bowling _ Activities That Are Limited To People With Disabilities _ Camping _ Running, Walking, or Aerobics _ Art (drawing, painting, ceramics, etc.) _ Photography _ Music and Television _ Social Functions (parties, visiting friends) _ Attending Sporting Events _ Basketball, Football, Softball, etc _ Other 13) If your son/daughter lived outside of your home in the community, you feel the risk for being taken advantage of sexually, physically, or financially is: _ High _ Moderate _ Low Adapted from Kent State University and Preparing for Life – Alabama State Department of Education 14) In surveying your own knowledge and feelings concerning the issues which pertain to your son/daughter, how well you feel you are prepared to deal with the future? _ Well Prepared and Knowledgeable _ Somewhat Nervous and Undecided _ Very Unsure and Nervous 15) In working with professionals, which agencies have you found particularly helpful in working with your son/daughter? _ The ARC _ Ability Alliance _ Parks and Recreation _ Easter Seals _ Department of Vocational Rehabilitation _ Department of Mental Health/Mental Retardation _ Department of Public Welfare _ Social Security Administration _ Public School System _ United Cerebral Palsy _ Faith Based Community Services _ Other (Specify) 16) To date, which has been your greatest source of information concerning services (independent living, community, recreational, or employment services) available to your son/daughter? _ Newspapers, Media _ Friends _ Family Members/Relatives _ School Officials/Teachers _ Found Out By Accident _ Found Out By Doing My Own Research _ None of the Above- I Don’t Have Necessary Information _ Other (Specify) _ 17) Which fears or anxieties you have which would prevent your son/daughter from living in a supported living environment in the community? _ Being Taken Advantage of _ Too Vulnerable _ Won’t Be Able To Take Good Care of Him/Herself _ Will Become Sexually Active _ Will Get Involved With Alcohol/Drugs _ Can’t Shop On His/Her Own _ Can’t Manage Money _ Not Really Ready Yet _ Has Been Too Dependent _ Caretaker Would Not Take Good Care Of My Son/Daughter _ Other (Specify) _ 18) What types of social media does your son/daughter use? _ Facebook _ Twitter _ E-mail _ Instragram/SnapChat _ Other: 19) To what degree they use these media sources? _ Frequently _ Moderately _ Rarely _ Never Adapted from Kent State University and Preparing for Life – Alabama State Department of Education 20) Do you monitor the use of these media sources? _ Yes, Often _ Yes, Some _ No 21) Does your son/daughter have any challenging behaviors that concern you or others? Explain: _ _ _ • What you when the behavior(s) occurs? _ _ _ 22) Describe your son/daughter’s behaviors in each of the following areas: Meal Time- Communication- Personal Hygiene- _ Socially- In the Community- School- _ 23) What things are important to you or your family members regarding programs that we have not discussed elsewhere in this survey? _ _ _ _ 24) List any other comments or concerns: _ _ _ _ _ Adapted from Kent State University and Preparing for Life – Alabama State Department of Education Transition Planning Assessment Directions: Please circle the number that best describes how you feel about the need for your son or daughter to receive instruction in each area Use the extra spaces for other needs NAME OF STUDENT: _ NAME OF PERSON COMPLETING ASSESSMENT: RELATIONSHIP TO STUDENT: DATE: _ Skill Great Need Moderate Need Little Need No Need 3 3 2 2 1 1 0 0 Sorting, washing, and drying Ironing Storage (folding, hanging up, putting in drawers) 3 2 1 0 Selection of clothing to wear according to time of year and weather conditions Other - 3 Cooking with Stove/Oven Cooking with Microwave Dishes by hand or using dishwasher (washing, drying, putting away) Menu Planning Eating (table manners, eating w/out assistance) Preparing meals for himself/herself 3 3 2 1 0 Other - HYGIENE AND GROOMING Toileting Bathing Oral Care (Teeth and gums) Shaving Hair Care (washing, drying, styling) Other - CARE OF CLOTHING FOOD RELATED Adapted from Kent State University and Preparing for Life – Alabama State Department of Education Skill Great Need Moderate Need Little Need No Need 3 3 3 2 2 2 1 1 1 0 0 0 3 3 3 3 3 2 2 1 1 0 0 3 3 2 2 1 1 0 0 3 3 HOME MAINTENANCE Mopping Sweeping Dusting Vacuuming Washing Windows Cleaning Mirrors Cleaning Bathroom (toilet, tub, sink, counter tops, ) Cleaning Kitchen (sink, stove, refrigerator, counter tops) Bed Making (making bed, changing sheets) Changing Light Bulbs Lawn Care Washing Cars Pet Care Other (Please Specify)- PERSONAL MANAGEMENT Getting himself/herself up in the morning with an alarm Using good judgment about going to bed on time Managing money effectively Managing time effectively Preparing meals for himself/herself Other - SHOPPING Shopping for Groceries Shopping for Clothing Shopping at a Convenience Store Other - COMMUNITY SKILLS Post Office (buying stamps, mailing letters, mailing packages) Bank (know how to open and maintain checking/savings account, how to cash checks, how to deposit money) Restaurants (ordering and paying for meal) Fast Food Restaurants (ordering and paying for meal) Adapted from Kent State University and Preparing for Life – Alabama State Department of Education Skill Demonstrate the use of public bus transportation Driver’s permit/license Give verbal directions to home Demonstrate Knowledge of Personal Information (e.g Address and Phone Number) Other - Great Need Moderate Need Little Need No Need 3 2 1 0 3 3 3 3 3 3 2 2 1 1 0 0 3 3 3 3 2 1 0 3 USE OF TELEPHONE Answers telephone appropriately and gets person requested Answers telephone, takes simple message, and verbally delivers it Makes local telephone calls and gives simple messages Looks up numbers in telephone book or online Knows how to call 911 or other emergency numbers Makes appointments (doctor, dentist, hair, etc.) Other - COMMUNICATION Asking for help/assistance Answering questions Engaging in social conversations Other - LEISURE/ RECREATION Development of skills for individual activities Development of skills for group activities Participate in community leisure activities Other - MEDICAL/SAFETY Demonstrate what to in emergency situation Demonstrate knowledge of basic first aid procedures Independently take medication Explain his/her disability to medical personnel Describe family medical history and any allergic reactions to medicine Demonstrate knowledge of medical insurance coverage Other - Adapted from Kent State University and Preparing for Life – Alabama State Department of Education Skill Great Need Moderate Need Little Need No Need 3 2 1 0 3 3 3 3 3 2 2 1 1 0 0 3 3 3 2 2 2 1 1 1 0 0 0 SELF DETERMINATION Participate in his/her IEP planning Participate in the development of long-range goals Express opinions and needs effectively Understand and effectively express strengths, as well as limitations/needs Demonstrate ability to ask for help when needed Set goals Take steps to achieve goals Demonstrate an understanding of his/her rights and responsibilities as a person with a disability Demonstrate assertiveness with friends and adults Show respect for self and others Handle praise and/or criticism Display self-confidence Demonstrate knowledge of the various adult programs/agencies available to him/her Other - Technology E-mail Text Messaging iPad Typing Skills Computer Processing Other- Adapted from Kent State University and Preparing for Life – Alabama State Department of Education