CCMEP Participant Exit Checklist

CCMEP Participant Exit Checklist
Name

First NameLast Name
Participant Start Date

MonthDayYear
Date
Proposed Exit Date

MonthDayYear
Date
WIOATANFCo-Enrolled
In School (14-21 be sure to plan for credential attainmentOut of School
YesNo
Employment,Military, Education (Participant is successful & no longer needs services)Awarded SSI/SSDI & made application with OODNon-Engagement / five failed attemptsNo longer eligible for fundingGlobally excluded per rule 5101:14-1-07
If box one is checked (Employment,Military, Education) provide details
YesNo
Training Provider Name & Location
Expected Graduation Date

MonthDayYear
Date
YesNo
Additional Details
YesNo
Branch
Position
Expected Yearly Salary
Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
Employer Name and Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Expected Weekly Earnings
Calculated Quarterly Earnings
Employer contact information

First NameLast Name
Employer Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employer Email
Social Media Address
YesNo
Exit Plan Details
Engagement Information
Phone/Cell/TextMail/Email AddressSocial Media
YesNo
YesNo
YesNo
Performance Measures

The following measures apply to ISY and OSY in education or training:
YesNo
Type of Gain
How the gain is documented (assessment,report card, etc.)?
Date information entered on skill gain tab?

MonthDayYear
Date
YesNo
Type of credential
YesNo
YesNo
The following three performance measures apply to all participants who are not globally excluded:
Education and Training 2nd Qtr After Exit
YesNo
YesNo
Education and Training 4th Qtr After Exit
YesNo
YesNo
The following measure is applicable if the participant was employed 2nd quarter after exit:
Wages for the Quarter
Hourly Wage x Hours per week x 13
YesNo
Decision
YesNo
YesNo
Comments
Case Manager Name
Case Manager Signature

Clear
Should be Empty: