Welcome to the Career Visions Forms Page!
last updated 08/23
Form
|
Comments
|
Print
|
Address Change Form
|
District approved address change form to be used for updating student mailing information. Fillable version must be downloaded to edit. Rev 9/2018
|
Are You Working? Letter
|
Written release authorizing case closure and current employment status for exited TPP clients.
|
Career Visions Release
of Information to Prospective Employers |
Disclosure authorization allowing the release of client information for the purpose of community based job development.
|
Career Visions
Workforce Preparation Curriculum (Rev 7/15 - District) |
PDF version of Career Visions' Workforce Preparation Curriculum including updated English standards compliance.
Section I - Assessment / Career Planning Section II - Community Awareness / Career Exploration Section III - Acquisition Section IV - Retention |
Career Visions
Workforce Preparation Portfolio (Adult Transition) |
PDF format of Adult Transition version of the Portfolio.
(Rev 5/2007) |
Conference Request Form
|
To be eligible for travel reimbursement, this form shall be properly completed and submitted for approval no less than 15 business days prior to departure.
|
Conference Expense Reimbursement Form
|
Attach a copy of the Authorization for Travel/Conference Attendance Form, and submit this form and any unused advanced funds within 10 working days following return from travel.
|
Direct Deposit Form
|
PDF version of LACOE Direct Deposit Form to be used for Students requesting direct checking / savings payroll deposit.
|
DOR Intake Checklist
|
Checklist highlights required documentation needed for
intake into the Transition Partnership Program. |
Potentially Eligible Cover Letter
|
Can be used to introduce parents / legal guardians to DOR Student Services prior to processing Potentially Eligible candidates.Must be downloaded to edit.
Rev 8/2018 |
DOR Student Service Request
|
Student service request (DR203). This form is intended to request student services for potentially eligible students, in accordance with 34 CFR 361.48(a). Student services may include any of the following pre-employment transition services: job exploration counseling, work-based learning experiences, postsecondary enrollment counseling, work readiness training, and self-advocacy training. “Potentially eligible” students are defined as students with disabilities, ages 16 through 21, who have not yet applied or been found eligible for the vocational rehabilitation program. This is not an application for vocational rehabilitation services. Please go to DR222 VOCATIONAL REHABILITATION SERVICES APPLICATION to access an application for vocational rehabilitation services. Sample fields are shown pre-populated. Must be downloaded to edit. Rev 12/2023
|
DOR Health Questionnaire
|
Client self disclosure completed when applying for services with the Department of Rehabilitation (DR218). This form identifies potential health related barriers to employment. Rev 7/2012
|
DOR Vocational Rehabilitation Services Application
|
Application for vocational services from
the Department of Rehabilitation (DR222). Rev 9/2011 |
DOR Supplemental Application Information
|
Additional Information requested when applying
for Department of Rehabilitation services (DR222A). Rev 4/2012 |
DOR Employment Record Disclosure
|
Self disclosure identifying potential client's work history and/or specialized vocational/certificate training when applying for services with the Department of Rehabilitation (DR222B).
|
DOR Consent to Release and Obtain Information (Potentially Eligible Consumers)
|
Disclosure authorization allowing for release of non medical student information when coordinating Student Services for Potentially Eligible (PE) Consumers with the Department of Rehabilitation (DR260). This form MUST be renewed annually. Sample fields are shown pre-populated. Must be downloaded to edit. Rev 12/2023
|
DOR Consent for Release of Non Medical Information
(Parent/Client) |
Disclosure authorization allowing for release of non medical student information when coordinating services with the Department of Rehabilitation (DR264)
|
DOR Consent for Release of Medical Information
(Parent/Client) |
Disclosure authorization allowing for release of medical information when coordinating student services with
the Department of Rehabilitation (DR264A) |
DOR Consent for Release of Non Medical Information
(District) |
Disclosure authorization allowing for release of non medical student information when coordinating services with the Department of Rehabilitation (DR264)
|
DOR Consent for Release of Medical Information
(District) |
Disclosure authorization allowing for release of medical information when coordinating student services with
the Department of Rehabilitation (DR264A) |
DOR Consent for Release of Non Medical Information
(Regional Center) |
Disclosure authorization allowing for release of non medical student information when coordinating services with the Department of Rehabilitation (DR264)
|
DOR Consent for Release
of Medical Information (Regional Center) |
Disclosure authorization allowing for release of medical information when coordinating student services with
the Department of Rehabilitation (DR264A) |
District Release
of Information |
Disclosure authorization allowing for release of confidential student information when coordinating services with non-District based providers.
(SELPA Mutual Exchange of Information) |
Eligibility Qualifiers
|
Details Career Visions program offerings and factors determining service eligibility.
|
Emergency Notification Form
|
Emergency release needed for CBI and / or Community Based Employment Training. 9/2018
|
Exit Interview
|
Should be given at termination of service to ensure accurate forwarding information for W2, while promoting program feedback and formal service closure.
|
I-9 Work Verification Form
|
Form I-9 required for all new student workers.
Revised 9/2022 |
Job Coaching
Service Log (Adult Transition) |
Service log used to document individualized Job Coaching time spent with a student in support of Adult Transition work training structure.
|
Mileage Expense Claim Form
|
To be submitted within 60 days following the date the expense was incurred. Expenses incurred during the last quarter of the fiscal year shall be submitted no later than 10 working days after June 30th. (2024)
|
OJT Application
|
Career Visions Employment Application form can be used as a training tool, and can be completed when applying at a work site where no formal application exists (eg. Trails, Heads Up, Sierra Vista JHS Campus Library).
|
OJT Application Follow Up Script
|
Career Visions Employment Application Follow Up Script can be used to facilitate a call of continued interest to a potential employer.
|
OJT Contract
(TLC) |
Subsidized work training contract (TLC). Note that contract requires a mandatory 8 week PAES evaluation period with a minimum 80% performance requirement before community based placement will be supported. Sponsoring employer agrees to review to hire after 50 hours of subsidy. Revised 8/2023
|
OJT Contract
(District) |
Subsidized work training contract (District). Note that contract supports an evaluation every 8 weeks, with review to hire after 50 hours of subsidy. Revised 8/2023
|
OJT Payroll Packet
(District) |
Payroll packet to be submitted and processed prior to beginning subsidized work training. Fillable forms must be downloaded to edit. 9/2020
|
OJT Timesheet
1st -15th |
Universal OJT Timesheet for all Career Visions
subsidized training sites. |
OJT Timesheet
16th - 31st |
Universal OJT Timesheet for all Career Visions
subsidized training sites. |
PARS - CTA
|
Personnel Activity Report to be filed monthly per DOR / TPP contract requirements. (Classified Version) 9/2018
|
PARS - Instructional Assitant
|
Personnel Activity Report to be filed monthly per DOR / TPP contract requirements. (School Staff Version) 9/2018
|
PARS - Teacher
|
Personal Activity Report to be filed monthly
per DOR / TPP contract requirements. 9/2018 (School Staff Version) |
Payroll Processing Schedule
(Subsidized) |
Career Visions Payroll processing schedule detailing timecard collection deadlines, and paycheck distribution dates for subsidized student participants.
|
Performance Evaluation
|
Progress evaluation given every 8 weeks to gauge work readiness. Form should be completed by sponsoring employer in accordance with OJT contract.
|
Portfolio Checklist
|
Workforce Preparation Portfolio Checklist. (Adult Transition)
|
Portfolio Checklist
|
Workforce Preparation Portfolio Checklist. (District)
|
Photo Release
|
District Photo Release for media coverage and program outreach activities.
|
Program Assumptions
(Adult Transition) |
Program Participation Assumptions for Adult Transition Students
|
Program Expectations
(District) |
Workforce Preparation requirements for the District.
|
Program Expectations
(Adult Transition) |
Workforce Preparation requirements for Adult Transition Students.
|
Seamless Transition Model 'STEPS'
(Adult Transition) |
Point of service model for the Adult Transition Students.
Workforce Preparation, OJT, and Seamless Transition. Revised 11/2014 |
Program Referral / Case Manager / Counselor Certification
(Non Editable) PDF Version |
Case Manager / Counselor certification submitted in conjunction with the completion of a Career Visions online application. Needed to initiate services, verify GPA, and gain parental and school consent. Also useful in screening for extracurricular activities conflict and alternative funding sources. (Rev 11/2016)
|
Program Referral / Case Manager / Counselor Certification
(Editable) MS Word Version |
Case Manager / Counselor certification submitted in conjunction with the completion of a Career Visions online application. Needed to initiate services, verify GPA, and gain parental and school consent. Also useful in screening for extracurricular activities conflict and alternative funding sources. (Rev 11/2016)
|
Program Application (Electronic)
|
Effective 9/2016 students can submit an application for program services by completing this electronic form. Kevin will review responses weekly and route completed applications to site CTAs.
|
Professional Growth Request
|
The CSEA/District classified contract provides full and complete reimbursement for Districtapproved
professional growth activities up to a maximum District cost of five hundred dollars ($500) per school year per unit member. The explanation and guidelines can be found on pages 49-50 of the CSEA contract (Article 17.3) listed under In-Service, Awards and Professional Growth. (Rev 5/2022) |
Psychological Update Form
|
Effective 4/08, a signed copy of this form can be submitted in lieu of a current psychological evaluation to meet TPP qualification standards.
(Note: This document must be completed by qualified personnel) |
Request for Specialized Job Development
|
Effective 1/12, this form must be completed to initiate CV supported direct hire / job development / placement services for exited / pre exited (where applicable) TPP clients requesting assistance.
|
Status Notice - TPP
|
Fillable Status Notice to be used for TPP new hires.
Form must be downloaded and saved before editing. Revised 11/2021 |
Status Notice - WAI
|
Fillable Status Notice to be used for WAI new hires.
Form must be downloaded and saved before editing. Revised 11/2021 |
Status Notice - WAI / Adult Transition
|
Fillable Status Notice to be used for WAI / Adult Transition new hires.
Form must be downloaded and saved before editing. Revised 11/2021 |
Download Form
|
Funding Change Status Notice - TPP to Workability
|
Fillable Status Notice to be used when changing work experience funding from TPP to WorkAbility I. Form must be downloaded and saved before editing. Revised 11/2021
|
Funding Change Status Notice - Workability I to TPP.
|
Fillable Status Notice to be used when changing work experience funding from WorkAbility I to TPP. Form must be downloaded and saved before editing. Revised 11/2021
|
Transition Evaluation Form
(High School) |
Evaluation should be administered at the start of the school year for strategic planning purposes. While this form is helpful, it does not satisfy grant requirements with regard to workforce preparation activities, assessment, and exploration.
|
Transition Evaluation Form
(Junior High School) |
Evaluation should be administered at the start of the school year for strategic planning purposes. While this form is helpful, it does not satisfy grant requirements with regard to workforce preparation activities, assessment, and exploration.
|
Transition Planning Profile
(Learn to Earn) |
LAUSD's Transition Planning Profile. May be used as an alternative to our Transition Evaluation Form.
|
TPP Candidate Selection Letter
MSWORD Version |
Notification of TPP selection. Letter outlines program services and participation requirements.
(Revised 4/14) |
TPP Goal Tracking Quarterly Report Matrix
|
Monthly goals and outcomes report summarizing PETS related program services offered to participating TPP clients. Download also includes a portion of PETS Scope of Work for reference if needed. Email to CV Office with monthly PARS when completed. Revised 11/2016.
|
TPP Monthly Progress Report
(Editable) Fillable MSWORD Version |
Monthly progress report detailing program services offered to all participating TPP clients. Report to be emailed to DOR counselor assigned to case by sponsoring CTA no later than the 10th of each month following prior month's end. Form must be downloaded and saved before editing.
Revised 9/2014 |
Transportation Request Form
|
Google form used to generate transportation quotes in support of CV related career exploration trips. Please remember to secure written permission from your school site prior to submitting this form. Revised 4/2022
|
Workers' Compensation Packet
|
WSHUHSD Workers Compensation Policies and Procedures (Revised 11/16)
|
Workers' Compensation Treatment Centers
|
Complete list of District authorized
Workers' Compensation Treatment Centers. (Revised 3/13) |
W4 Form
|
Completed Federal Form W-4 required for all new student workers. (2024)
|
DE4 Form
|
Completed State Form DE-4 required for all new student workers. (2024)
|