APPENDIX J

IPP Meeting Planner

This Work Sheet is to help you plan for the services you want to ask for from the regional center. Use it to help you think about the services you need to help you do all the things you want to do.

A PLACE TO LIVE

Where do you live now?

¨    My Own Place

¨    My Own Place with Roommates

¨    My Parent’s Place

¨    A Group Home

¨    A Large Care Facility

¨    Other:

Where do you want to live?

¨    Stay Where I Am

¨    My Own Place

¨    My Own Place with Roommates

¨    My Parent’s Place

¨    A Group Home

¨    A Large Care Facility

¨    Other:

What services do you need to help you live where you want?

¨    More Training

¨    An Attendant

¨    Someone to give me regular support and help

¨    More Money

¨    Help finding a place to live

¨    Other

A PLACE TO WORK

Where do you work now?

¨    In the Community without Extra Help

¨    In the Community with a Trainer or Aid

¨    In a Workshop or Center

¨    I go to School

¨    I don’t work or go to School

¨    Other:

Where do you want to work?

¨    In the Community

¨    In a Workshop or Center

¨    I want to go to School

¨    I don’t want to work

¨    Other:

What Services do you need to help you work?

¨    A Trainer or Aide at the job

¨    Training in a Workshop

¨    Other Training

¨    More Education

¨    Access to Work Place- Ramps, etc.

¨    Transportation

¨    Other:

What type of Medical Care do you need?

¨    Doctor Services

¨    Dentist Services

¨    Counseling

FUN AND LEISURE

What do you do for fun or with your free time?

¨    Visit Friends

¨    Shop

¨    Go to Movies or Plays

¨    Play Sports

¨    Hobby

¨    Watch TV

¨    Read

¨    Take Classes

¨    Volunteer Work

¨    Listen to Music

¨    Dating

¨    Other:

What new things do you want to do?

¨    Visit Friends

¨    Shop

¨    Go to Movies or Plays

¨    Play Sports

¨    Hobby

¨    Watch TV

¨    Read

¨    Take Classes

¨    Volunteer Work

¨    Listen to Music

¨    Dating

¨    Other:

What services do you need to help you do the things you want to do?

¨    Training

¨    Attendant

¨    Facilitator

¨    Transportation

¨    Set up a Circle of Friends

¨    Other:

OTHER THINGS

What other things do you think you need help with?

¨    Cooking for Myself

¨    Shopping for things I need

¨    Personal Care (For Example, IHSS)

¨    Cleaning my Place

¨    Managing my Money

¨    Getting Medical Care

¨    Medi-Cal

¨    Meeting More People/ Making Friends

¨    Riding the Bus or Other Transportation

¨    Learning about Personal Relationships

¨    Learning about Sexual Relationships and Safe Sex

¨    Self Advocacy and Knowing My Legal Rights

¨    Problems with Social Security, SSI or Other Money Assistance Programs

¨    Other:

What other services do you need to help with these things

¨    Training (What Type?)

¨    An Attendant

¨    A Chore Worker

¨    Just Someone to Ask Questions to

¨    Help Setting up a Circle of Friends

¨    An Advocate or Lawyer

¨    A Service Coordinator to help me plan for and get services I need

¨    Assistive Technology

¨    Other