AMP Individual Opportunity Plan (JFS 03005)

Individual Opportunity Plan (JFS-03005)

CCMEP provides employment, training and supportive services to mandatory and voluntary program participants based on a comprehensive assessment of each individual’s employment and training needs using the CCMEP Comprehensive Assessment (OWCMS, JFS 03003, and/or JFS 03006).
Participant Name
Date of IOP

MonthDayYear
Date
Participant Phone Number
Please enter a valid phone number.
Participant Email Address
example@example.com
Participant Date of Birth

MonthDayYear
Date
Last 4 of SSN*
AMP Coach
AMP Coach Email Address
AMP Coach Phone Number
Please enter a valid phone number.
Employment History
Employer Name 1
Job Title 1
Employment Start Date

MonthDayYear
Date
Employment End Date 1

MonthDayYear
Date
County of Employment 1
State of Employment 1
Employment Wage 1
Ex. $15.00/hour, $250.00/week
How many hours do you work a week on average?*
If you are still at the same employer did you receive a pay raise/decrease? Please provide details.*
Add starting wages and date of the increase/decrease.
Employer Name 2
Job Title 2
Employment Start Date 2

MonthDayYear
Date
Employment End Date 2

MonthDayYear
Date
County of Employment 2
State of Employment 2
Employment Wage 2
Ex. $15.00/hour, $250.00/week
How many hours do you work a week on average?*
If you are still at the same employer did you receive a pay increase/decrease? Please provide details.
Add starting pay rate and date and amount of any increase/decrease.
Target Occupation
What is the applicants target occupation that they want to pursue.
Link to a CCMEP performance goal (check at least one)

Obtain employment (full or part-time)Obtain a recognized post-secondary credentialObtain a secondary school diploma or its recognized equivalentComplete training or certificationIncrease earnings
Long-term goals (Career Pathway/ Training/ Education)
Are these goals for an in-demand career?
Yes No
Goal #1: Goal #2:
Short-term goals (Career Pathway/ Training/ Education)
Goal #1: Goal #2: Goal #3: Goal #4: Goal# 5: Goal #6:
Service #1
ONET Code (if needed)
Activity/Detail(s)
Location
Schedule/Frequency (including weekly hours)
Start Date

MonthDayYear
Date
Planned End Date

MonthDayYear
Date
Additional Instructions/Notes (including ADA modifications
Service #2
ONET Code (if needed)
Activity/Detail(s)
Location
Schedule/Frequency (including weekly hours)
Start Date

MonthDayYear
Date
Planned End Date

MonthDayYear
Date
Additional Instructions/Notes (including ADA modifications
Service #3
ONET Code (if needed)
Activity/Detail(s)
Location
Schedule/Frequency (including weekly hours)
Start Date

MonthDayYear
Date
Planned End Date

MonthDayYear
Date
Additional Instructions/Notes (including ADA modifications
Service #4
ONET Code (if needed)
Activity/Detail(s)
Location
Schedule/Frequency (including weekly hours)
Start Date

MonthDayYear
Date
Planned End Date

MonthDayYear
Date
Additional Instructions/Notes (including ADA modifications
Service #5
ONET Code (if needed)
Activity/Detail(s)
Location
Schedule/Frequency (including weekly hours)
Start Date

MonthDayYear
Date
Planned End Date

MonthDayYear
Date
Additional Instructions/Notes (including ADA modifications
Service #6
ONET Code (if needed)
Activity/Detail(s)
Location
Schedule/Frequency (including weekly hours)
Start Date

MonthDayYear
Date
Planned End Date

MonthDayYear
Date
Additional Instructions/Notes (including ADA modifications
Service #7
ONET Code (if needed)
Activity Default(s)
Location
Schedule/Frequency (including weekly hours)
Start Date

MonthDayYear
Date
Planned End Date

MonthDayYear
Date
Additional Instructions/Notes (including ADA modifications
Service #8
ONET Code (if needed)
Activity/Detail(s)
Location
Schedule/Frequency (including weekly hours)
Start Date

MonthDayYear
Date
Planned End Date

MonthDayYear
Date
Additional Instructions/Notes (including ADA modifications
Follow Up Services

(Follow Up occurs for at least for 12 months and Case Managers will engage at least once a month) Possible services include: 1) Supportive Services; 2)Financial Literacy Skills; 3) Adult Mentoring; 4) LMI/Career Counseling (i.e., Career Advancement advice); and 5) Activities that Prepare Participant for Transition to Post-secondary Education.
Follow-Up Service #1
Follow-Up Service #2
Follow-Up Service #3
Follow-Up Service #4
Follow-Up Service #5
Follow-Up Service #6
Follow-Up Service #7
Follow-Up Service #8
How often will my plan be changed?

I understand that my career coach will check-in with me at least every 30 days to assess and discuss my progress even after I am exited from the program to ensure my continued success. I am responsible for responding to my career coach and providing information as requested. Based on my progress and ongoing discussions with my career coach, this plan will be changed as needed.
Address completion status of Previous IOP Goals
List goals from previous IOP, Completion date, Completion status: Completed successfully, Incomplete
What are my rights and responsibilities?

· I agree that to achieve my goals identified in this plan and successfully enter a career, I will actively participate in services and strive towards reaching my goals.· I understand that this plan can be changed if something in my situation changes or my goals change, and that these changes will be documented in a new plan.· I have the right to request assistance and services that will help me achieve my goals and enter a career.· I have the right to request to be referred to an alternative provider or worksite if I object to a faith-based provider or worksite.
How will my career coach help me to achieve my goals?

My career coach will:· Treat me with courtesy, dignity, respect and without discrimination.· Assess my skills, employability and challenges to employment and/or education.· Help me identify life and career goals and provide services and supports needed to achieve these goals including any special accommodation needed if I have a disability.· Provide translation services if my primary language is not English or if I am hearing-impaired. My career coach will also provide key documents in my primary language or someone will be provided to translate the information on the documents into my primary language.· Provide me with a copy of my plan, including any future amendment(s).· Provide information on how I can appeal any decisions relating to the eligibility, enrollment, services or any other issues I may have regarding my participation in CCMEP.
Signature Agreement

I agree to follow this plan and understand that the plan can be changed if something in my circumstances change. Any plan changes will be in writing and signed by myself and my case manager. By signing this plan, I certify that I participated in the collaborative development of this plan and that I am committed to successfully achieving the goals and objectives outlined in this plan.
Participant Signature

Clear
Date

MonthDayYear
Date
Parent or Guardian Signature (If applicant is under age 18)

Clear
Date

MonthDayYear
Date
Case Manager Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Individual Opportunity Plan (JFS-03005)

Employment History

Follow Up Services

How often will my plan be changed?

What are my rights and responsibilities?

How will my career coach help me to achieve my goals?

Signature Agreement