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Young Adult Program
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Transition Skills Assessment
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Student Name:
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You must enter a number and not an "x" and it will total it for you.
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Domain A: Adult-Daily Living SkillsDate:Date:Date:
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Sub-Domain: Personal Information432104321043210
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1.1 Identifies basic information necessary to fill out forms and applications
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1.2 Writes and/or communicates personal information
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1.3 Respects the rights and privacy of self and others
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1.4 Identifies dangers of sharing personal information with potentially harmful individuals
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1.5 Identifies details of personal, school and work-related daily routine
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1.6 Identifies emergency contacts
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1.7 Can address a letter
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Sub-Domain: Hygiene432104321043210
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2.1 Follows acceptable hygiene practices (e.g., teeth, deodorant, shower/bath)
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2.2 Dresses appropriately for environment
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2.3 Dresses appropriately for weather
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2.4 Uses public and private toilets
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2.5 Wash hands and face: routine times and for specific activities
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2.6 Manage hair care (facial hair for men)
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2.7 Manage skin care
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2.8 Manage eye care needs
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2.9 Get dressed/undressed
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2.10 Maintain appearance
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2.11 Manage menstrual cycle
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Sub-Domain: Laundry
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3.1 Prepares laundry for wash
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3.2 Identifies washer and dryer products
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3.3 Appropriately measures cleaning products
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3.4 Operates washer and dryer
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3.5 Folds and/or hangs clothes appropriately
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3.6 Returns clean laundry to proper locations
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Sub-Domain: Meal Planning432104321043210
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4.1 Identifies food for a balanced diet (i.e., My Plate.gov - food choices, portions)
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4.2 Identifies product expiration dates/spoiled foods
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4.3 Identifies proper location for groceries
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4.4 Creates a grocery shopping list
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4.5 Shops and purchases items from grocery list (e.g., text or picture-supported)
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4.6 Plan menu for self/family/roommates
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Sub-Domain: Meal Preparation432104321043210
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5.1 Safely utilizes kitchen tools and appliances
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5.2 Identifies appropriate tools and/or appliances for meal preparation
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5.3 Demonstrates basic hygiene while preparing meals
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5.4 Demonstrates skills necessary to handle raw food (i.e., meat, fresh fruit/veggies)
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5.5 Identifies measuring utensils
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5.6 Utilizes measuring utensils accurately
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5.7 Follows recipe in correct sequence
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5.8 Cleans up self, table, and kitchen after cooking meals
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5.9 Operates dishwasher
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5.10 Cleans dishes effectively
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5.11 Safely disposes of trash
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5.12 Effectively cleans surface areas
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Sub-Domain: Time Management432104321043210
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6.1 Understands and utilizes clocks to tell time
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6.2 Understands and utilizes calendars
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6.3 Completes assigned tasks in a timely manner
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6.4 Manages unstructured time appropriately
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6.5 Understands appropriate wait time
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6.6 Identifies if a specific activity is in the morning, afternoon, or at night when given the time of the activity.
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6.7 Uses calendar/personal planner to keep track of personal activities (e.g., Dr. appointments, meetings, events).
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Sub-Domain: Self-Advocacy432104321043210
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7.1 Actively participates in IEP meetings
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7.2 Identifies personal strengths and limitations
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7.3 Identifies realistic personal goals
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7.4 Utilizes a support person appropriately to seek help when needed
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7.5 Actively participates in decisions that affect him/her personally (e.g., participates in meetings about him/herself)
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7.6 Expresses personal interests, wishes, concerns, opinions, feelings, ideas, and thoughts effectively (e.g., can fill out a transition survey or PCP-type questions)
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Sub-Domain: Personal Health432104321043210
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8.1 States negative effects of drug and alcohol use
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8.2 Know appropriate first-aid procedures: minor, major incidents
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8.3 Identifies good personal health habits (e.g., sleep exercise, physically active)
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8.4 Plan and participate in an exercise routine (e.g., walking, running, lifting)
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8.5 Participate in a variety of different exercise activities
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8.6 Take medicine as needed
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8.7 Inform others when sick / injured
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Sub-Domain: Money Management432104321043210
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9.1 Counts cash from $1.00 - $5.00
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9.2 Counts cash from $5.00 - $10.00
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9.3 Counts cash from $10.00 - $20.00
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9.4 Counts coins by $0.01
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9.5 Counts coins by $0.05
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9.6 Counts coins by $0.10
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9.7 Counts coins by $0.25
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9.8 Can state the next dollar up from $1 - $5
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9.9 Can state the next dollar up from $5 - $10
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9.10 Can state the next dollar up from $10 - $20
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9.11 Tracks deposits and purchases in a weekly/monthly budget
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Sub-Domain: Technology432104321043210
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10.1 Makes a phone call
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10.2 Answers a phone call
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10.3 Uses smartphone, tablet, or computer for ADL task (e.g., check weather, date, use calculator, tell time, send e-mail)