FLORIDA DIVISION OF VOCATIONAL REHABILITATION

SUPPORTED EMPLOYMENT

LONG-TERM SUPPORT PLAN

Long-Term-Support-Plan_Jose Alvarez.docx Page 1 of 2 Customer Name: Jose Alvarez VR ID Number: VR0813709 VR Counselor: Brenda Ocampo Provider Name: DMF Employment IPE Job Goal: Stock Clerks and Order Fillers Job/Position Title: Stock Associate Job Start Date: 10/26/2022 Stabilization Date: 12/9/2022 Projected Transition Date to

Extended Services:

2/8/23

Anticipated Extended

Services Provider and

Funding Source:

DMF Employment

Supports Identified for Success: List supports that are in currently in place and any additional supports identified for Extended Services

Transportation:

1. List current transportation: Drives self

2. Confirm transportation plan for future: Drives self Natural Supports on the Job Site:

1. List all current natural supports at the job site: Co-workers, supervisor, and support binder 2. List any additional natural supports anticipated for long term success: Jose will require prompts from co-workers when he loses focus or becomes anxious. Accommodations:

1. List all current accommodations: Job coach support, prompting for focus, workplace etiquette reminders, timers on phone

2. List any additional accommodations that are anticipated N/A

Job Coaching:

1. Current average hours of support: 8 hours per month 2. Anticipated average number of hours needed in the future: 2-4 hours per month Advancement Opportunities: List strategies to assist Customer to advance their career: Job coach will work with supervisor to identify possible advancements and additional tasks If Customer receives benefits, who is responsible to assist with appropriate reporting? Job coach/parent

Other: Click or tap here to enter text.

FLORIDA DIVISION OF VOCATIONAL REHABILITATION

SUPPORTED EMPLOYMENT

LONG-TERM SUPPORT PLAN

Long-Term-Support-Plan_Jose Alvarez.docx Page 2 of 2 REQUIRED SIGNATURES:

Customer Signature: Date: 2/8/23 Parent/Guardian Signature: Date: 2/8/23

(if Applicable)

I hereby attest, to the best of my knowledge, the above information is correct. VR reserves the right to suspend Provider registration if VR suspects the Provider has knowingly falsified this document, or otherwise engaged in fraudulent activity.

Provider Signature: Jill Brookner Date: 2/8/23

Provider Printed Name: Jill Brookner

If you have any difficulty regarding accessibility of this form or any data fields, contact Vocational Rehabilitation: adxcuf@r.postjobfree.com The Florida Department of Education, Division of Vocational Rehabilitation (VR) is an equal opportunity employer. It is against the law for VR as a recipient of Federal financial assistance to discriminate against any individual in the United States on the basis of race, color, religion, sex, national origin, age, disability, political affiliation or belief. The application process used by VR to determine eligibility for services, any subsequent services and the entire VR process are subject to these non-discrimination requirements. Auxiliary aids and services are available upon request to individuals with disabilities. VR program receives 78.7 percent of its funding through a grant from the U.S. Department of Education. For the 2020 Federal fiscal year, the total amount of grant funds awarded were $153,000,001. The remaining 21.3 percent of the costs ($41,409,148) were funded by Florida State Appropriations. Revised October 2020. La División de Rehabilitación Vocacional (RV) del Departamento de Educación de Florida es un empleador que ofrece igualdad de oportunidades. Es contra la ley que RV como beneficiario de asistencia federal discrimine contra cualquier persona en los Estados Unidos por motivos de raza, color, religión, sexo, origen nacional, edad, discapacidad, afiliación política o creencia. El proceso de solicitud utilizado por RV para determinar la elegibilidad para servicios, los servicios posteriores y el proceso entero de RV son sujeto a estos requisitos de no discriminación. Las ayudas y servicios auxiliares están disponibles a pedido a las personas con discapacidades. El programa RV recibe 78.7 por ciento de su financiamiento a través de una subvención del Departamento de Educación de los EE. UU. Para el año fiscal federal 2020 el monto total de los fondos de la subvención otorgados fue de $153,000,001. El restante 21.3 por ciento de los costos ($41,409,148) fueron financiados por las Apropiaciones del estado de Florida. Revisado en octubre de 2020.