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Parent
Referral
Community Based
Transition Center, Address: 525 W. Casino Road, Everett, WA. 425-356-1275
CBTC Mission Statement:
Bridge the gap between High School and Adult Life
by providing opportunities for students to gain skills and community connections needed
for a successful transition.
Student Name
Date
Parents Names
Address
Home Phone
Work Phone
Email:
Cell Phone
1.
A student at the age of 18 legally becomes his/her own guardian and the school
district at that time works directly with the student; A release of information is
required for communication with the parents. Which applies best to your situation?
My adult child is
his/her own guardian
We have
completed the legal guardianship procedures
(Please provide documentation to the IEP
manager)
2.
What are your childs strengths?
3.
Are academic classes a priority for your adult child at this time?
4.
Will your adult child be able to work independently on a job? if, no, please
explain:
5.
Will your adult child need supports in their adult life? If yes, Please list or
what are your questions?
6.
List community agencies your adult child is currently accessing (please
include source of medical coverage):
7.
List job experiences (employment, non-paid, chores etc.)
Parent Signature
____________________________________________________
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Student
Referral
Community Based Transition Center, Address:
525 W. Casino Road, Everett, WA. 425-356-1275
CBTC Mission Statement:
Bridge the gap between High School and Adult Life
by providing opportunities for students to gain skills and community connections needed
for a successful transition.
Name
Date
Address
Home Phone
Cell Phone
Email:
The Community Based
Transition Center provides special education services to students eighteen and older who
require specially designed instruction to meet the intended outcomes identified on the
transition pages of the IEP.
A student at the age of
18 legally becomes his/her own guardian. The school district and greater community at that
time work directly with the student as an adult. A release of information is required to
communicate with the parents.
What would you like to
learn more about in your community? (What are your transition goals?)
What are your
strengths? What do you do well?
What instruction do you
require to meet your goals for transition out of high school?
Please write questions
you have:
Student Signature:
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