INSTRUCTIONS: Answer the following questions that relate to the student for a specific activity. The more positive responses to the questions the more appropriate the selected activity will be.

Activity: ________________________________________________

Number of "Yes" Responses: ______________________________

Appropriate

____Does the activity selected reflect those of age appropriate nondisabled peers?

____Do opportunities for travel exist within the activity?

____Does the activity focus on the student's strengths?

____Are the travel situations and expectations found within the activity similar to the student's peer group?

____Is the student going where peers typically go and do?


Functional

____Is the student learning skills, including travel skills that increase independence?

____Is the student able to complete a task or activity, without someone else providing assistance?

____Would learning certain skills allow the student to travel safely and efficiently?


Generalize

____Is the student learning skills, including travel skills, where and when the skills are needed?

____Is there an expectation the student will generalize these skills to other environments or activities?

____Could the student use these skills across more environments or activities?


Social Relationships

____Have social relationships been considered when selecting the location and activity?

____Does the student have both the opportunity and the means to interact with nondisabled peers?

____Will the activity provide greater opportunities to be included with nondisabled peers?

____Is this an activity with the same types of travel opportunities that are likely to occur when the student leaves school or their current living situation?

____Will natural supports be available? (Complete after Phase 8)Parent, Guardian, and Student Input

____Has the family had an opportunity to share their priorities?

____Has the student had an opportunity to share his or her preferences?

____Is there an increased probability the student will make choices, develop skills, or actively participate in the home if his or her priorities are recognized?