How to access the information on this page:
- Directly on this page.
- This assessment is designed to provide information on the areas of need for the older youth on whose behalf you’re advocating.
- This form should be completed by you (the CASA/GAL volunteer) after you have had a chance to speak with a youth about his/her situation and expressed wishes (some of the questions on this form may help guide some of the conversations you have with your youth)
- Note that the forms you can download above allow for notetaking and checklisting. The version below gives general questions to consider and links for more information.
|Education will be one focus of my work, advocacy and action planning with this youth.
Youth is enrolled in school.
Youth has a person to help him/her make decisions
Youth has an academic plan with academic-related goals for the future.
Youth is literate and has the ability to read and write.
Youth plans to attend college or a vocational school
Wright State Independent Scholars program
Youth needs tutoring services for _________________________ If needed, youth is receiving tutoring services.
Youth has copies/access to educational records.
Give a brief summary of youth’s educational progress, needs and challenges:
Youth has been enrolled at _____________ school and has ______________ credits toward graduation. He/she needs _________ total credits to graduate. Youth has passed the follow OGTs: ___reading ___writing ___math ___science ___social studies
Youth has missed _____ days in school year ___________.
Youth has participated in a vocational assessment.
Youth has expressed wanting a job and has established employment goals
Youth has at least two (2) people from whom he/she may obtain references for employment: ________________________________________ and ____________________________________.
Youth has filled out a job application.
Youth has adequate interviewing skills.
Youth has appropriate clothing for a job interview.
Youth has been involved in volunteer service or an internship.
Youth has a telephone number, a library card and a personal calendar for appointments.
Youth has a Social Security card, birth certificate and other important documentation for employment.
What are the youth’s employment goals and needs?
Youth has been exposed to life skills topics including housing issues, budgeting and independent living.
Youth understands the concept of “independent living.”
Youth has been exposed to information on legal rights and responsibilities regarding housing:
Ohio Tenant/Landlord Rights and Obligations
Youth is able to create and maintain a budget.
Youth has a plan for permanent housing.
Cincinnati Metropolitan Housing
US Department of Housing and Urban Development
Youth is connected to a person who can help conduct a housing search.
Youth has knowledge of financial assistance he/she may have access to in order to pursue housing/independent living.
Summarize youth’s current living situation and plans for the future including for plans after emancipation and whether or not youth has applied for affordable housing:
Life skills will be one focus of my work, advocacy and action planning with this youth.
Youth knows how to make healthy decisions and advocate on his/her own behalf.
Youth knows the social, emotional and legal risks associated with alcohol, drug and tobacco use and understands the impact of peer pressure.
Youth can make well thought out decisions and can problem solve.
Youth knows how to appropriately respond to prejudice and discrimination.
Youth understands the importance of good hygiene.
Youth knows how to stay healthy and care for minor illnesses.
Youth understands the basic concept of nutrition and knows how to prepare basic meals.
Youth understands services provided by a bank such as checking and savings accounts and how to make a basic budget.
Youth has a checking and/or savings account.
Youth has a driver’s license.
What life skills does the youth have? What skills does the youth need acquire and who can support the youth in learning these skills?
Supportive Relationships/Community Resources
Relationships and resources will be one focus of my work, advocacy and action planning with this youth.
Youth has at least one meaningful adult connection in whom he/she can trust.
Youth is connected to at least one adult mentor.
Youth has a healthy connection to at least one peer.
Youth has contact information of community legal resources, attorneys, case workers and mentors.
Youth has a healthy sense of ethnicity, cultural identity and personal identity.
Youth has the ability/opportunity to create, maintain and strengthen supportive and sustaining relationships with foster families and significant others.
Youth has the ability/opportunity to create, maintain and strengthen supportive and sustaining relationships with members of his/her birth family.
Youth understands civic responsibility and is registered to vote.
Who are the supportive people in the youth’s life? Is the youth connected to any organization/group outside of HCJFS, ProKids or other “system” providers and if so who?
Health will be one focus of my work, advocacy and action planning with this youth.
Youth has had a comprehensive screening to assess physical health, developmental needs, mental health and substance abuse.
Youth has been exposed to information about healthy social relationships, home safety, preventing accidents and violence.
Youth has an understanding of issues related to STI’s and HIV.
Youth has the skills to maintain good emotional and physical health.
Youth has a copy of all medical, dental and mental health records.
Youth has information and appropriate understanding of any ongoing medical, dental or mental health conditions.
American Academy of Child & Adolescent Psychiatry
Youth knows what medications (if any) he/she is currently taking.
Youth is covered by Medicaid or another insurance plan (currently).
Youth is covered by Medicaid or another insurance plan (once he/she emancipates from the system).
Youth understand what (if any) SSI benefits he/she is eligible for.
Youth knows and understands when and how to seek medical attention.
Where does the youth seek medical care? What conditions and/or mental health diagnoses does youth have? What medications is youth currently prescribed? If youth is taking medications do they know names of medications and what they treat?
Assessment tool based on Benchmarks/Criteria resource developed by New Mexico’s Power Up program