Youth Enrollment Package

Please download the following .pdf attachment and complete the forms prior to filling out the remaining information. These forms will be required to be uploaded in order to submit this form.

Youth Assessment and Individual Service Strategy

Short Term Occupational Goal

Long Term Occupational Goal

O*Net Code

Customer

is unemployed

is receiving unemployment insurance

has exhausted unemployment

Customer is unsure of, or has no goal, multiple unrelated goals, or outlook unfavorable for goal.

Customer identifies need to change career or explore other options

Knowledge/Skills/Abilities

Customer has not identified any skills or displays an inability to clearly articulate skills/abilities.

Customer speaks English with difficulty.

English language comprehension level:

Weak

Poor

Average

Customer appears to lack basic reading and writing skills.

Customer disclosed a disability or received education assistance in school.

Customer needs help to identify a job appropriate for his/her aptitudes, interests, or work values.

Customer lacks basic computer skills.

Customer lacks training to support occupational goal.

Additional Issues/Barriers

Customer identified a health restriction or other wellness-related barrier to employment.

Customer is in a mental health, drug & alcohol, or recovery treatment program.

Customer exhibits a hygiene issue that can impact a successful job search.

Customer lacks stable housing

Customer is a foster child or has aged out of the foster care system.

Employment Related Issues/Barriers

Customer has an unstable work history or multiple terminations.

Customer has background check issues or has been involved with the criminal justice system.

Customer lacks ability to get to work.

Customer is currently pregnant and/or parenting.

Customer has no positive work references.

Job Search Knowledge and Skills

Customer lacks awareness of necessary job search skills.

Customer has history of unsuccessful job search.

Customer lacks job search tools: resume, cover letter, interviewing skills, and interpersonal skills.

Framework of an ISS:

  Directly linked to one or more indicators of performance

Based on the objective assessment

Identifies a career pathway that includes education and employment goals

Brief Assessment Overview

Identify personal, educational, occupational, financial, medical, childcare, transportation, housing, food/nutrition

Strengths

Challenges/Barriers

Service/Resource/Partner Agency Referral

Goals

Identify personal, educational, and occupational short - and long - term goals

Goal Type

Short - Term Goal (3 months or less)

Long - Term Goal (4 months or more)

Potential Barriers to Goal Achievement:

Case Notes/ISS Review Updates: Include any progress, such as but not limited to measurable skill gains, other goal completions

Youth and Case Manager Agreements:

For Youth - I agree to:

Contact my Case Manager monthly or as often as necessary to update my progress on this plan. I understand that my case can be closed if I go 90 days without participating in a service .

Let my Case Manager know of any problems which would cause changes to any activities or interfere with completing the plan.

Seek, accept and maintain employment that meets my planned goal(s) as stated above.

Contact my Case Manager when I become employed, and provide all necessary information pertaining to the job.

Stay in contact with my Case Mana ger for up to a year after exiting the program to maintain and support meeting my goals.

For the Case Manager - I agree to:

Assist with the appropriate career guidance, training and supportive services.

Coordinate with other agencies and programs to help you obtain needed services.

Monitor your participation and progress in the activities above.

Assist you in your search for employment.

Maintain contact with you for up to one year after you obtain employment for employment retention and career advance ment purposes.

The following are digital signatures. Please use your mouse or cursor to sign below.

Participant Signature

Coordinator Signature

Upload Youth Enrollment Documents

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