Form Wtw 18 - Learning Needs Screening
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4STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
LEARNING NEEDS SCREENING
Directions for County Worker:
1. Before asking the questions on this form, give the client form WTW 19 (Learning Needs Screening - Client Copy) so
he or she can follow along and read the questions silently as you read them aloud.
2. Before proceeding to the Learning Needs Screening questions on the following pages, read the following preamble
aloud to the client:
PREAMBLE:
I am going to ask you questions about your school experiences and your health. Your answers will help me figure out
what, if anything, is getting in your way of training and working. Your answers will also help me develop your welfare-
to-work plan and help me figure out what services you may need to be successfully employed. It is very important that
you answer these questions so that I can determine the right kind of welfare-to-work activities for you, and to get you
the help and services you may need to succeed. These questions are not intended to determine the existence of a
learning disability. They are only the first step in the evaluation process.
Please keep in mind that most people with learning disabilities are intelligent and many are gifted. Individuals with a
learning disability may have difficulty with the following:
• Reading
• Math
• Listening
• Organizing things
• Understanding directions
• Getting along with others
• Writing
• Expressing ideas out loud
• Spelling
• Paying attention
Individuals with a learning disability can be taught to use their strengths and find ways to make it easier to learn and
be more successful at school and on the job. I can help individuals get the appropriate welfare-to-work activities,
including accommodations once a learning disability is identified.
Please keep in mind this screening is a very simple and short test. It will help you decide if you would like a referral to
a learning disability specialist for an evaluation to find out if a learning disability exists. The areas that will be tested at
evaluation are the following:
• Natural talents and abilities
• Ability to follow verbal and written information
• Achievement
• Job and Career interests
The specialist can help identify strengths and weaknesses so that we can make referrals to the appropriate services
and accommodations for you. Please remember that you have the right to file for a fair hearing if you disagree with a
county action including actions related to learning disabilities.
If you are Limited-English proficient and a Learning Needs Screening is not available in your primary language, you
have the right to request a referral directly for a learning disabilities evaluation.
3.
REFUSAL TO BE SCREENED OR EVALUATED: If the client makes the decision to not be screened, read the WTW
17 form (Waiver of CalWORKs Learning Disabilities Screening and/or Evaluation) to the client and explain the
importance and benefits of a learning disabilities screening and/or a learning disabilities evaluation. Do not offer the
waiver in lieu of offering the screening or evaluation. If the client still does not want to be screened or evaluated, have
the client sign the WTW 17 form. Give a copy of the form to the client and retain the original in the case file.
WTW 18 (4/16) COVERSHEET - REQUIRED FORM - NO SUBSTITUTES PERMITTED
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