CCMEP IOP Form 3005

COMPREHENSIVE CASE MANAGEMENT AND EMPLOYMENT PROGRAM (CCMEP) INDIVIDUAL OPPORTUNITY PLAN
Ohio Department of Job and Family Services

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
Name*
Phone*
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Last four of SSN or Seeker ID*
Case Manager Name*
Phone*
Email
example@example.com
Date

MonthDayYear
Date
Employment History (Leave end date blank for current employment)
Employment History - Employer Name
Employment History - Job Title
End Date

MonthDayYear
Date
County
State
Wage
Employment History - Employer Name
Employment History - Job Title
End Date

MonthDayYear
Date
County
State
Wage
Link to a CCMEP performance goal (check at least one)

Obtain employment (full or part-time)Complete training or certificationObtain a recognized post-secondary credentialIncrease earningsObtain a secondary school diploma or its recognized equivalent
Long-term goals (Career Pathway/ Training/ Education) Are these goals for an in-demand career?

YesNo
Short-term goals (Career Pathway/ Training/ Education)
Long Term Goal 1
Long Term Goal 2
Short Term Goal 1
Short Term Goal 2
Short Term Goal 3
Short Term Goal 4
Short Term Goal 5
Short Term Goal 6
ONET Code (if needed) 1
Activity/Detail(s) 1 practice
Location 1
Schedule/Frequency (including weekly hours) 1
Start Date 1

MonthDayYear
Date
Planned End Date 1

MonthDayYear
Date
Additional Instructions/Notes (including ADA modifications) 1
Service 2
ONET Code (if needed) 2
Activity/Detail(s) 2
Location 2
Schedule/Frequency (including weekly hours) 2
Start Date 2

MonthDayYear
Date
Planned End Date 2

MonthDayYear
Date
Additional Instructions/Notes (including ADA modifications) 2
Service 3
ONET Code (if needed) 3
Activity/Detail(s) 3
Location 3
Schedule/Frequency (including weekly hours) 3
Start Date 3

MonthDayYear
Date
Planned End Date 3

MonthDayYear
Date
Additional Instructions/Notes (including ADA modifications) 3
Service 4
ONET Code (if needed) 4
Activity/Detail(s) 4
Location 4
Schedule/Frequency (including weekly hours) 4
Start Date 4

MonthDayYear
Date
Planned End Date 4

MonthDayYear
Date
Additional Instructions/Notes (including ADA modifications) 4
Service 5
ONET Code (if needed) 5
Activity/Detail(s) 5
Location 5
Schedule/Frequency (including weekly hours) 5
Start Date 5

MonthDayYear
Date
Planned End Date 5

MonthDayYear
Date
Additional Instructions/Notes (including ADA modifications) 5
Service 6
ONET Code (if needed) 6
Activity/Detail(s) 6
Location 6
Schedule/Frequency (including weekly hours) 6
Start Date 6

MonthDayYear
Date
Planned End Date 6

MonthDayYear
Date
Additional Instructions/Notes (including ADA modifications) 6
Service 7
ONET Code (if needed) 7
Activity/Detail(s) 7
Location 7
Schedule/Frequency (including weekly hours) 7
Start Date 7

MonthDayYear
Date
Planned End Date 7

MonthDayYear
Date
Additional Instructions/Notes (including ADA modifications) 7
Service 8
ONET Code (if needed) 8
Activity/Detail(s) 8
Location 8
Schedule/Frequency (including weekly hours) 8
Start Date 8

MonthDayYear
Date
Planned End Date 8

MonthDayYear
Date
Additional Instructions/Notes (including ADA modifications) 8
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 Follow-Up Service
Follow Up Service
Follow Up Service
Follow Up Service
Follow Up Service
Follow Up Service
Follow Up Service
Follow Up Service
Follow Up Service
How often will my plan be changed? I understand that my career coach will check-ir with me at least every 30 days to assess and discuss my progress even after I am exited from the program to ensuremy 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. 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 accom modation 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 hav e regarding my participation in CCMEP.

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 applicantisunderage 18)

Clear
Date

MonthDayYear
Date
I understand that this plan can be changed if something in the participant's situation changes. Any plan changes will be in writing and signed by myself (or another case manager) and the participant. By signing this plan, I certify that I participated in the collaborative development of this plan and that I am committed to assisting the participant to successfully achieve the goals and objectives outlined in this plan.
Case Manager Signature

Clear
Date

MonthDayYear
Date
How was this form completed with the client?
Case Manager Name
Title
Should be Empty:

COMPREHENSIVE CASE MANAGEMENT AND EMPLOYMENT PROGRAM (CCMEP) INDIVIDUAL OPPORTUNITY PLAN