Form Step 8 - Supportive Transitional Emancipation Program Transitional Independent Living Plan Page 2

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My plan to achieve these goals are:
1.
____________________________________________________________________________________________________
2.
____________________________________________________________________________________________________
3.
____________________________________________________________________________________________________
My educational Service Provider is:___________________________________________________________________________
They will help me achieve these goals by:
1.
____________________________________________________________________________________________________
2.
____________________________________________________________________________________________________
3.
____________________________________________________________________________________________________
Date projected to complete my educational goals:___________________ Proof that I am achieving my education goals (attach ):
I have attached the following documents to verify the progress I’ve made toward my educational goals: _____________________
Financial Aid/Scholarship Information
I currently receive (please mark all that apply) :
Financial Aid
Scholarship
Grant
Other:_________________________________________________
Please specify what is received:
1.
____________________________________________________________________________________________________
2.
____________________________________________________________________________________________________
3.
____________________________________________________________________________________________________
If I do not currently have Financial Aid/scholarship information and would like to obtain information about available options my
Service Provider will help me achieve this by:
1.
____________________________________________________________________________________________________
2.
____________________________________________________________________________________________________
3.
____________________________________________________________________________________________________
Summer Plans
During the summer break, my plans are:
1.
____________________________________________________________________________________________________
2.
____________________________________________________________________________________________________
3.
____________________________________________________________________________________________________
Additional Information
Other information/interests that help me to achieve my educational goals (ie. volunteer work, sport teams, etc.) :
1.
____________________________________________________________________________________________________
2.
____________________________________________________________________________________________________
3.
____________________________________________________________________________________________________
EMPLOYMENT
)
(Current Employment
START DATE:
PLACE OF EMPLOYMENT:
JOB TITLE:
JOB RESPONSIBILITIES:
CURRENT WORK SCHEDULE:
HOURS i WORK PER WEEK:
RATE OF PAY:
1-10
11-20
21-30
31-40
$
per hour
SHIFT I WORK:
Other (specify) :
Day
Swing
Evening
Grave
SUPERVISOR/CONTACT PERSON:
TELEPHONE:
(
)
PROOF OF EMPLOYMENT (ATTACH) :
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