WF: Objective Assessment

WF: Objective Assessments

Basic Skills, Occupational & Work Experience

Participant Name

CM Email(Required)

Program

WIOA PART ID

SNAP CAN ID

WIOA: Additional Assistance*

Must checkbox at least one of these to determine Additional Assistance Needed barrier for WIOA.

Selection of at least one of the above determines and verifies Additional Assistance Needed barrier for WIOA. Note: i.a, i.b, iii – should be included in review of basic skills assessment. If any have been marked, BSD barrier may be applicable.

ASSESSMENT INSTRUCTIONS:

Case Manager will begin by reviewing Intake Document, ISS Goals and any pending enrollment items. File all 3 documents (Intake, CCA Goals & Objective Assessment) in client’s SharePoint file.

PRESUMPTIVE NEED ASSESSMENT: This form is designed to document need for services for Basic Skills/Education, Occupational Skills, Work Experience, Work History and variety of other needs, interests and aptitudes. If need for services is determined. the applicant/participant is eligible to receive corresponding service.

Check the box for “YES, True” response, Leave box blank for “NO, False” response.
Score = Total in Category (#) minus “Yes/True” = Total for category.

An assessment score below the maximum indicates a presumptive need for services (and may indicate barrier) to address identified gaps or barriers. Max score per section is indicated in parentheses.

Notes/Comments and proof/documentation may be included to explain and verify responses.

Education, Basic Skills, English:

Education – Basic Skills & English (8)(Required)

I can follow basic written instructions and diagrams with no help or just a little help.

I can fill out basic medical forms and job applications.

I can add, subtract, multiply and divide with whole numbers up to 3 digits, without the aid of a calculator? (For example, 144 divided by 12 =)

English is mine and my family’s primary language.

I speak and read English well enough to get and keep a job.

I have had 3 years of formal education in the English Language.

I can do basic tasks on a computer or smart phone.

I was able to complete this basic skills assessment without help.

None of the Above = 0

EDU – BS & ELL Score (8)

(8) – High score = low need. Low score = high need.

Education – OUT [*] Credits Remaining for High School Completion

The statewide minimum course of study requires students to take a minimum of 22 credits for HSD. GED is considered HSE. Earning of HSD or HSE may indicates no Basic Skills Deficiency barrier present.

Less than 5 Credits Remaining

5-10 Credits Remaining

More than 10 Credits Remaining

None Remaining, Holds HSD or HSE

Education – IN or OUT: Post Secondary Transition (6)(Required)

I have considered Post-Secondary options or know where I will be attending Post-Secondary.

I have visited my or a college campus and feel comfortable navigating Post-Secondary school.

I have taken an online college course and feel comfortable navigating the virtual platform.

I have applied for FASFA and scholarships.

I qualify for financial aid grants/scholarships and will not use loans or pay nothing out of pocket.

I have family members that have attended college.

None of the Above = 0

EDU – Post-Sec Score (6)

(6) – High score = low need. high score = low need.

If any question is answered “NO”, further verification may be needed for eligibility barrier of BSD or ELL, using acceptable eligibility verification and documentation (see 300.301 Attachment C) approved assessment or school records and case note.

Occupational Skills:

This form is designed to document need for training in the Occupational Skills area (Onsite or Classroom Occupational Skills). If need for training. is determined. the applicant/participant is eligible for a “Skill Attainment – Occupational Skills ” outcome. If need is not established, an outcome other than “Skill Attainment – Occupational Skills will be necessary.

Assessments: 1. Experience in the occupation. 2. Completed training (received a certificate or credential) in the occupation. 3. More than 3 months of experience in the occupation.

Occupational Skills Training (3)(Required)

I have experience in the occupation in which training will be provided.

I have successfully completed training (received a certificate or credential) in the occupation in which training will be provided.

I have more than 3 months of experience in the occupation in which training will be provided.

None of the Above = 0

OST Score (3)

(3) – High score = high need. Low score = low need.

Work Readiness Skills & Work Experience:

This form is designed to document need for training in the Work Readiness Skills and Work Experience areas. If need for training is determined, the applicant is eligible for necessary services.

Assessments: Career Explorations, Resume, Interview Prep, Professionalism, Attitude, Communication and Problem Solving. Transferable Skills. Work History, Job Search, Applications, Job Market and Labor Information

Work Readiness Skills (12)(Required)

Transferable Skills(Required)

Select any that apply –

WR Skills Score (12)

(12) – High score = low need. Low score = high need.

Work Experience (7)(Required)

I have experience or work history within the career I am interested in.

I have worked within the last 6 months.

I know how to navigate job applications and am confident in submitting them.

I know where to search for job opportunities.

I am content with how much I make in wages. I do not desire to make more.

I have professional references and recommendations from previous employers.

I have a mentor in the career I am interested in.

None of the Above = 0

Work Experience Score (7)

(7) – High score = high need. Low score = low need.

Work History(Required)

Use PLUS (+) on the right side to add more work history lines. Please Include your previous 3 employments in the following format: Employer Name, Title: Start Date – End Date, Hourly Wage For Example: McDonalds, Cashier: March 2022 – June 2023, $15/hour || If participants do not have work experience – enter “none” in text box below

Entrepreneurship:

Entrepreneurial Assessment (4)(Required)

When I set a goal, I have will power and self discipline to complete it.

I have an idea for a service or product that meets a need or want in my community.

I have worked in a business similar to my business idea.

I have been operating a business model or service temporarily or sporadically.

None of the Above = 0

Entrepreneur Score (4)

(4) – High score = high need. Low score = low need.

Additional Elements & Supportive Services:

Champions – List 1-3 people you would consider your champion. What is your relationship to them (Friend, Parent, Family member)?(Required)

Social / Emotional Health (5)(Required)

I often have interest or pleasure in doing things.

I often feel I have control over the important things in life.

I feel confident about my ability to handle my personal problems.

I have friends and/or family that I can turn to in times of need.

I have a trusted adult that I am able to safely share about my life with.

None of the Above = 0

Social / Emotional Score (5)

(5) – High score = low need. Low score = high need.

Financial Literacy (4)(Required)

I have a Bank Account and regularly use it.

I have savings / set aside money for emergencies.

I have NOT received Public Support of any kind in the last month.

I have never taken out a payday loan, defaulted on loans or missed credit card payments.

None of the Above = 0

Financial Lit Score (4)

(4) – High score = low need. Low score = high need.

Transportation (3)(Required)

I have a valid drivers license.

I own a vehicle and can rely on it for transportation.

Participation in this program will add NO extra miles to my normal commute.

None of the Above = 0

Transportation Score (3)

(3) – High score = low need. Low score = high need.

Additional Notes

Signature

I acknowledge that the information I have provided during this objective assessment is true and accurate to the best of my knowledge. I understand that this assessment is being used to help determine my presumptive need for program assistance and that additional documentation may be required.

Participant Signature

Date

Staff Signature

Date