Vocational & Direction Assessment

Section 1 — Your Information

Parent or guardian contact details

Your Name *

Relationship to Young Adult *

Best Phone Number *

Email Address *

Town / Zip Code

Preferred Way to Reach You

Phone CallText MessageEmailAny of the above

Section 2 — About Your Young Adult

Basic background and current services

Young Adult's Name *

Age

Date of Birth

Diagnosis / Life Challenge (check all that apply)

Current Services or Supports (check all that apply)

Funding Source for Community Mapper Service

Section 3 — Interests & Strengths

Help us find activities they will genuinely love

Top Interests or Hobbies (check all that apply)

Greatest Strengths

What are they particularly proud of or excited about right now?

Section 4 — Community Goals

What does success look like for your young adult?

What does your young adult hope to gain? (check all that apply)

In your own words, what would a successful community experience look like?

Are there any types of activities or settings you would like to avoid?

Section 5 — Availability & Schedule

Fill in the days and times that work best

How often would they ideally participate?

Any scheduling conflicts we should know about?

Section 6 — Support Needs

Help us understand how best to support your young adult

Transportation Support Needed?

Level of Community Support Needed

Communication Preferences or Needs (check all that apply)

Verbal communication — no concernsUses AAC device or alternative communicationPrefers written or text-based communicationBenefits from visual supports or social storiesMay need extra time to process and respond

Other:

Sensory Sensitivities or Environmental Considerations

Behavioral or Safety Considerations

Relevant Medical Information

Section 7 — Additional Information

How did you hear about Progress Partners?

Anything else we should know before we get started?

Section 8 — Consent & Signature

Please review and confirm before submitting

By submitting this form, I confirm that the information provided is accurate to the best of my knowledge and that I give permission for my young adult to participate in Progress Partners Community Mapper activities. I understand that all information shared will be kept confidential and used solely to support my young adult's community participation.

Printed Name *

Date *

I agree to the above consent statement and confirm this information is accurate. *

Parent / Guardian Intake Form