individual: interviewer: date: friendships, as well as to...
TRANSCRIPT
Copyright copy DS Division Page 1 of 11 Vinfen Corporation 2017
COMMUNITY INTEREST SURVEY
Complete for each Full ISP or as changes occur Individual ___________________________________ Interviewer ___________________________________ Date ___________________________________ Focus on community activities that allow for opportunities to build connections relationships and friendships as well as to develop roles such as leader companion member organizer supporter etc These could be through volunteer and educational opportunities as well as activities in their local community The following is a list of activities and events as well as interest areas Interest areas should be explored in the community rather than just solely at the program (ie joining a knitting meet-up group painting events in the community movies at theaters or at parks etc) Amusement park arcades
No
Interest
Somewhat interested
Very
interested
Animal shelterszoos
No
Interest
Somewhat interested
Very
interested
Arts amp crafts
No
Interest
Somewhat interested
Very
interested
Barbequescookouts
No
Interest
Somewhat interested
Very
interested
Baseball
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 2 of 11 Vinfen Corporation 2017
Basketball
No
Interest
Somewhat interested
Very
interested
Billiardspool
No
Interest
Somewhat interested
Very
interested
Board games gaming groups
No Interest
Somewhat interested
Very interested
Bowling
No
Interest
Somewhat interested
Very
interested
Bridges
No
Interest
Somewhat interested
Very
interested
Camping
No
Interest
Somewhat interested
Very
interested
Carstrucks
No
Interest
Somewhat interested
Very
interested
Ceramics
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 3 of 11 Vinfen Corporation 2017
Collecting
No
Interest
Somewhat interested
Very
interested
Concerts
No
Interest
Somewhat interested
Very
interested
Cooking
No
Interest
Somewhat interested
Very
interested
Crafts
No
Interest
Somewhat interested
Very
interested
Cruises-vacation or short day
No
Interest
Somewhat interested
Very
interested
Cultural festivals
No
Interest
Somewhat interested
Very
interested
Dancing
No
Interest
Somewhat interested
Very
interested
Dating
No
Interest
Somewhat interested
Very
interested
Decorating
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 4 of 11 Vinfen Corporation 2017
Exercise
No
Interest
Somewhat interested
Very
interested
Fairs
No
Interest
Somewhat interested
Very
interested
Flower shows
No
Interest
Somewhat interested
Very
interested
Football
No
Interest
Somewhat interested
Very
interested
Fruit picking-fall foliage
No
Interest
Somewhat interested
Very
interested
Gardening
No
Interest
Somewhat interested
Very
interested
Going to churchtempleother
No
Interest
Somewhat interested
Very
interested
Golf
No
Interest
Somewhat interested
Very
interested
Hairstyling
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 5 of 11 Vinfen Corporation 2017
Historyhistorical sites
No
Interest
Somewhat interested
Very
interested
Holiday Events Celebrations
No
Interest
Somewhat interested
Very
interested
Jewelry making
No
Interest
Somewhat interested
Very
interested
Knitting
No
Interest
Somewhat interested
Very
interested
Learning and using public transportation
No
Interest
Somewhat interested
Very
interested
Libraries
No
Interest
Somewhat interested
Very
interested
Lighthouses
No
Interest
Somewhat interested
Very
interested
Miniature golf
No
Interest
Somewhat interested
Very
interested
Model building groups at stores
No
Interest
Somewhat interested
Very
interested
Movies
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 6 of 11 Vinfen Corporation 2017
Musicmusicals
No
Interest
Somewhat interested
Very
interested
Musical instrument playing
No
Interest
Somewhat interested
Very
interested
Open air concerts
No
Interest
Somewhat interested
Very
interested
Out for ice cream
No
Interest
Somewhat interested
Very
interested
Painting
No
Interest
Somewhat interested
Very
interested
Parties
No
Interest
Somewhat interested
Very
interested
Photography
No
Interest
Somewhat interested
Very
interested
Picnics
No
Interest
Somewhat interested
Very
interested
Ping pong
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 7 of 11 Vinfen Corporation 2017
Plays and Broadway shows
No
Interest
Somewhat interested
Very
interested
Poetry readings
No
Interest
Somewhat interested
Very
interested
Politics
No
Interest
Somewhat interested
Very
interested
Public gardensgreenhouses
No
Interest
Somewhat interested
Very
interested
Puzzles
No
Interest
Somewhat interested
Very
interested
Radio (visit stations)
No
Interest
Somewhat interested
Very
interested
Reading
No
Interest
Somewhat interested
Very
interested
Religious events
No
Interest
Somewhat interested
Very
interested
Restaurants (excludes fast food and drive-thru)
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 8 of 11 Vinfen Corporation 2017
Self-advocacy meetings human rights safety etc
No
Interest
Somewhat interested
Very
interested
Senior centers
No
Interest
Somewhat interested
Very
interested
Sewing
No
Interest
Somewhat interested
Very
interested
Shopping
No
Interest
Somewhat interested
Very
interested
Shows
No
Interest
Somewhat interested
Very
interested
Singing
No
Interest
Somewhat interested
Very
interested
Soccer
No
Interest
Somewhat interested
Very
interested
Social clubs
No
Interest
Somewhat interested
Very
interested
Swimming
No
Interest
Somewhat interested
Very
interested
Symphony hall
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 9 of 11 Vinfen Corporation 2017
Taking an educational class
No
Interest
Somewhat interested
Very
interested
Taking tours around Boston police stations fire stations airport sports stadiums
No
Interest
Somewhat interested
Very
interested
Television
No
Interest
Somewhat interested
Very
interested
Tennis
No
Interest
Somewhat interested
Very
interested
Traveling
No
Interest
Somewhat interested
Very
interested
Visiting art galleries
No
Interest
Somewhat interested
Very
interested
Visiting churchescathedrals
No
Interest
Somewhat interested
Very
interested
Visiting family
No
Interest
Somewhat interested
Very
interested
Visiting friends
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 10 of 11 Vinfen Corporation 2017
Visiting museums
No
Interest
Somewhat interested
Very
interested
Volleyball
No
Interest
Somewhat interested
Very
interested
Volunteering
No
Interest
Somewhat interested
Very
interested
Walking-beachparksforests
No
Interest
Somewhat interested
Very
interested
Writing
No
Interest
Somewhat interested
Very
interested
Yard sales
No
Interest
Somewhat interested
Very
interested
YMCA
No
Interest
Somewhat interested
Very
interested
OTHER ListDescribe
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 11 of 11 Vinfen Corporation 2017
Individual _______________________________________________________ Date _____________
Once this assessment has been completed with the individual have a discussion about which activities theyrsquove identified would be most important to focus on this ISP cycle and how they might like to access these activities For day programs identify interests that are available during day time hours The focus of these should be activities that are not currently part of the individualrsquos routine List the activities to focus on _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________
Ensure the Community Map aligns with this list
EFFECTIVE DATE 12016 REVISION DATE 4242017
Copyright copy DS Division Page 2 of 11 Vinfen Corporation 2017
Basketball
No
Interest
Somewhat interested
Very
interested
Billiardspool
No
Interest
Somewhat interested
Very
interested
Board games gaming groups
No Interest
Somewhat interested
Very interested
Bowling
No
Interest
Somewhat interested
Very
interested
Bridges
No
Interest
Somewhat interested
Very
interested
Camping
No
Interest
Somewhat interested
Very
interested
Carstrucks
No
Interest
Somewhat interested
Very
interested
Ceramics
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 3 of 11 Vinfen Corporation 2017
Collecting
No
Interest
Somewhat interested
Very
interested
Concerts
No
Interest
Somewhat interested
Very
interested
Cooking
No
Interest
Somewhat interested
Very
interested
Crafts
No
Interest
Somewhat interested
Very
interested
Cruises-vacation or short day
No
Interest
Somewhat interested
Very
interested
Cultural festivals
No
Interest
Somewhat interested
Very
interested
Dancing
No
Interest
Somewhat interested
Very
interested
Dating
No
Interest
Somewhat interested
Very
interested
Decorating
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 4 of 11 Vinfen Corporation 2017
Exercise
No
Interest
Somewhat interested
Very
interested
Fairs
No
Interest
Somewhat interested
Very
interested
Flower shows
No
Interest
Somewhat interested
Very
interested
Football
No
Interest
Somewhat interested
Very
interested
Fruit picking-fall foliage
No
Interest
Somewhat interested
Very
interested
Gardening
No
Interest
Somewhat interested
Very
interested
Going to churchtempleother
No
Interest
Somewhat interested
Very
interested
Golf
No
Interest
Somewhat interested
Very
interested
Hairstyling
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 5 of 11 Vinfen Corporation 2017
Historyhistorical sites
No
Interest
Somewhat interested
Very
interested
Holiday Events Celebrations
No
Interest
Somewhat interested
Very
interested
Jewelry making
No
Interest
Somewhat interested
Very
interested
Knitting
No
Interest
Somewhat interested
Very
interested
Learning and using public transportation
No
Interest
Somewhat interested
Very
interested
Libraries
No
Interest
Somewhat interested
Very
interested
Lighthouses
No
Interest
Somewhat interested
Very
interested
Miniature golf
No
Interest
Somewhat interested
Very
interested
Model building groups at stores
No
Interest
Somewhat interested
Very
interested
Movies
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 6 of 11 Vinfen Corporation 2017
Musicmusicals
No
Interest
Somewhat interested
Very
interested
Musical instrument playing
No
Interest
Somewhat interested
Very
interested
Open air concerts
No
Interest
Somewhat interested
Very
interested
Out for ice cream
No
Interest
Somewhat interested
Very
interested
Painting
No
Interest
Somewhat interested
Very
interested
Parties
No
Interest
Somewhat interested
Very
interested
Photography
No
Interest
Somewhat interested
Very
interested
Picnics
No
Interest
Somewhat interested
Very
interested
Ping pong
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 7 of 11 Vinfen Corporation 2017
Plays and Broadway shows
No
Interest
Somewhat interested
Very
interested
Poetry readings
No
Interest
Somewhat interested
Very
interested
Politics
No
Interest
Somewhat interested
Very
interested
Public gardensgreenhouses
No
Interest
Somewhat interested
Very
interested
Puzzles
No
Interest
Somewhat interested
Very
interested
Radio (visit stations)
No
Interest
Somewhat interested
Very
interested
Reading
No
Interest
Somewhat interested
Very
interested
Religious events
No
Interest
Somewhat interested
Very
interested
Restaurants (excludes fast food and drive-thru)
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 8 of 11 Vinfen Corporation 2017
Self-advocacy meetings human rights safety etc
No
Interest
Somewhat interested
Very
interested
Senior centers
No
Interest
Somewhat interested
Very
interested
Sewing
No
Interest
Somewhat interested
Very
interested
Shopping
No
Interest
Somewhat interested
Very
interested
Shows
No
Interest
Somewhat interested
Very
interested
Singing
No
Interest
Somewhat interested
Very
interested
Soccer
No
Interest
Somewhat interested
Very
interested
Social clubs
No
Interest
Somewhat interested
Very
interested
Swimming
No
Interest
Somewhat interested
Very
interested
Symphony hall
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 9 of 11 Vinfen Corporation 2017
Taking an educational class
No
Interest
Somewhat interested
Very
interested
Taking tours around Boston police stations fire stations airport sports stadiums
No
Interest
Somewhat interested
Very
interested
Television
No
Interest
Somewhat interested
Very
interested
Tennis
No
Interest
Somewhat interested
Very
interested
Traveling
No
Interest
Somewhat interested
Very
interested
Visiting art galleries
No
Interest
Somewhat interested
Very
interested
Visiting churchescathedrals
No
Interest
Somewhat interested
Very
interested
Visiting family
No
Interest
Somewhat interested
Very
interested
Visiting friends
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 10 of 11 Vinfen Corporation 2017
Visiting museums
No
Interest
Somewhat interested
Very
interested
Volleyball
No
Interest
Somewhat interested
Very
interested
Volunteering
No
Interest
Somewhat interested
Very
interested
Walking-beachparksforests
No
Interest
Somewhat interested
Very
interested
Writing
No
Interest
Somewhat interested
Very
interested
Yard sales
No
Interest
Somewhat interested
Very
interested
YMCA
No
Interest
Somewhat interested
Very
interested
OTHER ListDescribe
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 11 of 11 Vinfen Corporation 2017
Individual _______________________________________________________ Date _____________
Once this assessment has been completed with the individual have a discussion about which activities theyrsquove identified would be most important to focus on this ISP cycle and how they might like to access these activities For day programs identify interests that are available during day time hours The focus of these should be activities that are not currently part of the individualrsquos routine List the activities to focus on _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________
Ensure the Community Map aligns with this list
EFFECTIVE DATE 12016 REVISION DATE 4242017
Copyright copy DS Division Page 3 of 11 Vinfen Corporation 2017
Collecting
No
Interest
Somewhat interested
Very
interested
Concerts
No
Interest
Somewhat interested
Very
interested
Cooking
No
Interest
Somewhat interested
Very
interested
Crafts
No
Interest
Somewhat interested
Very
interested
Cruises-vacation or short day
No
Interest
Somewhat interested
Very
interested
Cultural festivals
No
Interest
Somewhat interested
Very
interested
Dancing
No
Interest
Somewhat interested
Very
interested
Dating
No
Interest
Somewhat interested
Very
interested
Decorating
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 4 of 11 Vinfen Corporation 2017
Exercise
No
Interest
Somewhat interested
Very
interested
Fairs
No
Interest
Somewhat interested
Very
interested
Flower shows
No
Interest
Somewhat interested
Very
interested
Football
No
Interest
Somewhat interested
Very
interested
Fruit picking-fall foliage
No
Interest
Somewhat interested
Very
interested
Gardening
No
Interest
Somewhat interested
Very
interested
Going to churchtempleother
No
Interest
Somewhat interested
Very
interested
Golf
No
Interest
Somewhat interested
Very
interested
Hairstyling
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 5 of 11 Vinfen Corporation 2017
Historyhistorical sites
No
Interest
Somewhat interested
Very
interested
Holiday Events Celebrations
No
Interest
Somewhat interested
Very
interested
Jewelry making
No
Interest
Somewhat interested
Very
interested
Knitting
No
Interest
Somewhat interested
Very
interested
Learning and using public transportation
No
Interest
Somewhat interested
Very
interested
Libraries
No
Interest
Somewhat interested
Very
interested
Lighthouses
No
Interest
Somewhat interested
Very
interested
Miniature golf
No
Interest
Somewhat interested
Very
interested
Model building groups at stores
No
Interest
Somewhat interested
Very
interested
Movies
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 6 of 11 Vinfen Corporation 2017
Musicmusicals
No
Interest
Somewhat interested
Very
interested
Musical instrument playing
No
Interest
Somewhat interested
Very
interested
Open air concerts
No
Interest
Somewhat interested
Very
interested
Out for ice cream
No
Interest
Somewhat interested
Very
interested
Painting
No
Interest
Somewhat interested
Very
interested
Parties
No
Interest
Somewhat interested
Very
interested
Photography
No
Interest
Somewhat interested
Very
interested
Picnics
No
Interest
Somewhat interested
Very
interested
Ping pong
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 7 of 11 Vinfen Corporation 2017
Plays and Broadway shows
No
Interest
Somewhat interested
Very
interested
Poetry readings
No
Interest
Somewhat interested
Very
interested
Politics
No
Interest
Somewhat interested
Very
interested
Public gardensgreenhouses
No
Interest
Somewhat interested
Very
interested
Puzzles
No
Interest
Somewhat interested
Very
interested
Radio (visit stations)
No
Interest
Somewhat interested
Very
interested
Reading
No
Interest
Somewhat interested
Very
interested
Religious events
No
Interest
Somewhat interested
Very
interested
Restaurants (excludes fast food and drive-thru)
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 8 of 11 Vinfen Corporation 2017
Self-advocacy meetings human rights safety etc
No
Interest
Somewhat interested
Very
interested
Senior centers
No
Interest
Somewhat interested
Very
interested
Sewing
No
Interest
Somewhat interested
Very
interested
Shopping
No
Interest
Somewhat interested
Very
interested
Shows
No
Interest
Somewhat interested
Very
interested
Singing
No
Interest
Somewhat interested
Very
interested
Soccer
No
Interest
Somewhat interested
Very
interested
Social clubs
No
Interest
Somewhat interested
Very
interested
Swimming
No
Interest
Somewhat interested
Very
interested
Symphony hall
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 9 of 11 Vinfen Corporation 2017
Taking an educational class
No
Interest
Somewhat interested
Very
interested
Taking tours around Boston police stations fire stations airport sports stadiums
No
Interest
Somewhat interested
Very
interested
Television
No
Interest
Somewhat interested
Very
interested
Tennis
No
Interest
Somewhat interested
Very
interested
Traveling
No
Interest
Somewhat interested
Very
interested
Visiting art galleries
No
Interest
Somewhat interested
Very
interested
Visiting churchescathedrals
No
Interest
Somewhat interested
Very
interested
Visiting family
No
Interest
Somewhat interested
Very
interested
Visiting friends
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 10 of 11 Vinfen Corporation 2017
Visiting museums
No
Interest
Somewhat interested
Very
interested
Volleyball
No
Interest
Somewhat interested
Very
interested
Volunteering
No
Interest
Somewhat interested
Very
interested
Walking-beachparksforests
No
Interest
Somewhat interested
Very
interested
Writing
No
Interest
Somewhat interested
Very
interested
Yard sales
No
Interest
Somewhat interested
Very
interested
YMCA
No
Interest
Somewhat interested
Very
interested
OTHER ListDescribe
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 11 of 11 Vinfen Corporation 2017
Individual _______________________________________________________ Date _____________
Once this assessment has been completed with the individual have a discussion about which activities theyrsquove identified would be most important to focus on this ISP cycle and how they might like to access these activities For day programs identify interests that are available during day time hours The focus of these should be activities that are not currently part of the individualrsquos routine List the activities to focus on _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________
Ensure the Community Map aligns with this list
EFFECTIVE DATE 12016 REVISION DATE 4242017
Copyright copy DS Division Page 4 of 11 Vinfen Corporation 2017
Exercise
No
Interest
Somewhat interested
Very
interested
Fairs
No
Interest
Somewhat interested
Very
interested
Flower shows
No
Interest
Somewhat interested
Very
interested
Football
No
Interest
Somewhat interested
Very
interested
Fruit picking-fall foliage
No
Interest
Somewhat interested
Very
interested
Gardening
No
Interest
Somewhat interested
Very
interested
Going to churchtempleother
No
Interest
Somewhat interested
Very
interested
Golf
No
Interest
Somewhat interested
Very
interested
Hairstyling
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 5 of 11 Vinfen Corporation 2017
Historyhistorical sites
No
Interest
Somewhat interested
Very
interested
Holiday Events Celebrations
No
Interest
Somewhat interested
Very
interested
Jewelry making
No
Interest
Somewhat interested
Very
interested
Knitting
No
Interest
Somewhat interested
Very
interested
Learning and using public transportation
No
Interest
Somewhat interested
Very
interested
Libraries
No
Interest
Somewhat interested
Very
interested
Lighthouses
No
Interest
Somewhat interested
Very
interested
Miniature golf
No
Interest
Somewhat interested
Very
interested
Model building groups at stores
No
Interest
Somewhat interested
Very
interested
Movies
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 6 of 11 Vinfen Corporation 2017
Musicmusicals
No
Interest
Somewhat interested
Very
interested
Musical instrument playing
No
Interest
Somewhat interested
Very
interested
Open air concerts
No
Interest
Somewhat interested
Very
interested
Out for ice cream
No
Interest
Somewhat interested
Very
interested
Painting
No
Interest
Somewhat interested
Very
interested
Parties
No
Interest
Somewhat interested
Very
interested
Photography
No
Interest
Somewhat interested
Very
interested
Picnics
No
Interest
Somewhat interested
Very
interested
Ping pong
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 7 of 11 Vinfen Corporation 2017
Plays and Broadway shows
No
Interest
Somewhat interested
Very
interested
Poetry readings
No
Interest
Somewhat interested
Very
interested
Politics
No
Interest
Somewhat interested
Very
interested
Public gardensgreenhouses
No
Interest
Somewhat interested
Very
interested
Puzzles
No
Interest
Somewhat interested
Very
interested
Radio (visit stations)
No
Interest
Somewhat interested
Very
interested
Reading
No
Interest
Somewhat interested
Very
interested
Religious events
No
Interest
Somewhat interested
Very
interested
Restaurants (excludes fast food and drive-thru)
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 8 of 11 Vinfen Corporation 2017
Self-advocacy meetings human rights safety etc
No
Interest
Somewhat interested
Very
interested
Senior centers
No
Interest
Somewhat interested
Very
interested
Sewing
No
Interest
Somewhat interested
Very
interested
Shopping
No
Interest
Somewhat interested
Very
interested
Shows
No
Interest
Somewhat interested
Very
interested
Singing
No
Interest
Somewhat interested
Very
interested
Soccer
No
Interest
Somewhat interested
Very
interested
Social clubs
No
Interest
Somewhat interested
Very
interested
Swimming
No
Interest
Somewhat interested
Very
interested
Symphony hall
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 9 of 11 Vinfen Corporation 2017
Taking an educational class
No
Interest
Somewhat interested
Very
interested
Taking tours around Boston police stations fire stations airport sports stadiums
No
Interest
Somewhat interested
Very
interested
Television
No
Interest
Somewhat interested
Very
interested
Tennis
No
Interest
Somewhat interested
Very
interested
Traveling
No
Interest
Somewhat interested
Very
interested
Visiting art galleries
No
Interest
Somewhat interested
Very
interested
Visiting churchescathedrals
No
Interest
Somewhat interested
Very
interested
Visiting family
No
Interest
Somewhat interested
Very
interested
Visiting friends
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 10 of 11 Vinfen Corporation 2017
Visiting museums
No
Interest
Somewhat interested
Very
interested
Volleyball
No
Interest
Somewhat interested
Very
interested
Volunteering
No
Interest
Somewhat interested
Very
interested
Walking-beachparksforests
No
Interest
Somewhat interested
Very
interested
Writing
No
Interest
Somewhat interested
Very
interested
Yard sales
No
Interest
Somewhat interested
Very
interested
YMCA
No
Interest
Somewhat interested
Very
interested
OTHER ListDescribe
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 11 of 11 Vinfen Corporation 2017
Individual _______________________________________________________ Date _____________
Once this assessment has been completed with the individual have a discussion about which activities theyrsquove identified would be most important to focus on this ISP cycle and how they might like to access these activities For day programs identify interests that are available during day time hours The focus of these should be activities that are not currently part of the individualrsquos routine List the activities to focus on _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________
Ensure the Community Map aligns with this list
EFFECTIVE DATE 12016 REVISION DATE 4242017
Copyright copy DS Division Page 5 of 11 Vinfen Corporation 2017
Historyhistorical sites
No
Interest
Somewhat interested
Very
interested
Holiday Events Celebrations
No
Interest
Somewhat interested
Very
interested
Jewelry making
No
Interest
Somewhat interested
Very
interested
Knitting
No
Interest
Somewhat interested
Very
interested
Learning and using public transportation
No
Interest
Somewhat interested
Very
interested
Libraries
No
Interest
Somewhat interested
Very
interested
Lighthouses
No
Interest
Somewhat interested
Very
interested
Miniature golf
No
Interest
Somewhat interested
Very
interested
Model building groups at stores
No
Interest
Somewhat interested
Very
interested
Movies
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 6 of 11 Vinfen Corporation 2017
Musicmusicals
No
Interest
Somewhat interested
Very
interested
Musical instrument playing
No
Interest
Somewhat interested
Very
interested
Open air concerts
No
Interest
Somewhat interested
Very
interested
Out for ice cream
No
Interest
Somewhat interested
Very
interested
Painting
No
Interest
Somewhat interested
Very
interested
Parties
No
Interest
Somewhat interested
Very
interested
Photography
No
Interest
Somewhat interested
Very
interested
Picnics
No
Interest
Somewhat interested
Very
interested
Ping pong
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 7 of 11 Vinfen Corporation 2017
Plays and Broadway shows
No
Interest
Somewhat interested
Very
interested
Poetry readings
No
Interest
Somewhat interested
Very
interested
Politics
No
Interest
Somewhat interested
Very
interested
Public gardensgreenhouses
No
Interest
Somewhat interested
Very
interested
Puzzles
No
Interest
Somewhat interested
Very
interested
Radio (visit stations)
No
Interest
Somewhat interested
Very
interested
Reading
No
Interest
Somewhat interested
Very
interested
Religious events
No
Interest
Somewhat interested
Very
interested
Restaurants (excludes fast food and drive-thru)
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 8 of 11 Vinfen Corporation 2017
Self-advocacy meetings human rights safety etc
No
Interest
Somewhat interested
Very
interested
Senior centers
No
Interest
Somewhat interested
Very
interested
Sewing
No
Interest
Somewhat interested
Very
interested
Shopping
No
Interest
Somewhat interested
Very
interested
Shows
No
Interest
Somewhat interested
Very
interested
Singing
No
Interest
Somewhat interested
Very
interested
Soccer
No
Interest
Somewhat interested
Very
interested
Social clubs
No
Interest
Somewhat interested
Very
interested
Swimming
No
Interest
Somewhat interested
Very
interested
Symphony hall
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 9 of 11 Vinfen Corporation 2017
Taking an educational class
No
Interest
Somewhat interested
Very
interested
Taking tours around Boston police stations fire stations airport sports stadiums
No
Interest
Somewhat interested
Very
interested
Television
No
Interest
Somewhat interested
Very
interested
Tennis
No
Interest
Somewhat interested
Very
interested
Traveling
No
Interest
Somewhat interested
Very
interested
Visiting art galleries
No
Interest
Somewhat interested
Very
interested
Visiting churchescathedrals
No
Interest
Somewhat interested
Very
interested
Visiting family
No
Interest
Somewhat interested
Very
interested
Visiting friends
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 10 of 11 Vinfen Corporation 2017
Visiting museums
No
Interest
Somewhat interested
Very
interested
Volleyball
No
Interest
Somewhat interested
Very
interested
Volunteering
No
Interest
Somewhat interested
Very
interested
Walking-beachparksforests
No
Interest
Somewhat interested
Very
interested
Writing
No
Interest
Somewhat interested
Very
interested
Yard sales
No
Interest
Somewhat interested
Very
interested
YMCA
No
Interest
Somewhat interested
Very
interested
OTHER ListDescribe
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 11 of 11 Vinfen Corporation 2017
Individual _______________________________________________________ Date _____________
Once this assessment has been completed with the individual have a discussion about which activities theyrsquove identified would be most important to focus on this ISP cycle and how they might like to access these activities For day programs identify interests that are available during day time hours The focus of these should be activities that are not currently part of the individualrsquos routine List the activities to focus on _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________
Ensure the Community Map aligns with this list
EFFECTIVE DATE 12016 REVISION DATE 4242017
Copyright copy DS Division Page 6 of 11 Vinfen Corporation 2017
Musicmusicals
No
Interest
Somewhat interested
Very
interested
Musical instrument playing
No
Interest
Somewhat interested
Very
interested
Open air concerts
No
Interest
Somewhat interested
Very
interested
Out for ice cream
No
Interest
Somewhat interested
Very
interested
Painting
No
Interest
Somewhat interested
Very
interested
Parties
No
Interest
Somewhat interested
Very
interested
Photography
No
Interest
Somewhat interested
Very
interested
Picnics
No
Interest
Somewhat interested
Very
interested
Ping pong
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 7 of 11 Vinfen Corporation 2017
Plays and Broadway shows
No
Interest
Somewhat interested
Very
interested
Poetry readings
No
Interest
Somewhat interested
Very
interested
Politics
No
Interest
Somewhat interested
Very
interested
Public gardensgreenhouses
No
Interest
Somewhat interested
Very
interested
Puzzles
No
Interest
Somewhat interested
Very
interested
Radio (visit stations)
No
Interest
Somewhat interested
Very
interested
Reading
No
Interest
Somewhat interested
Very
interested
Religious events
No
Interest
Somewhat interested
Very
interested
Restaurants (excludes fast food and drive-thru)
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 8 of 11 Vinfen Corporation 2017
Self-advocacy meetings human rights safety etc
No
Interest
Somewhat interested
Very
interested
Senior centers
No
Interest
Somewhat interested
Very
interested
Sewing
No
Interest
Somewhat interested
Very
interested
Shopping
No
Interest
Somewhat interested
Very
interested
Shows
No
Interest
Somewhat interested
Very
interested
Singing
No
Interest
Somewhat interested
Very
interested
Soccer
No
Interest
Somewhat interested
Very
interested
Social clubs
No
Interest
Somewhat interested
Very
interested
Swimming
No
Interest
Somewhat interested
Very
interested
Symphony hall
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 9 of 11 Vinfen Corporation 2017
Taking an educational class
No
Interest
Somewhat interested
Very
interested
Taking tours around Boston police stations fire stations airport sports stadiums
No
Interest
Somewhat interested
Very
interested
Television
No
Interest
Somewhat interested
Very
interested
Tennis
No
Interest
Somewhat interested
Very
interested
Traveling
No
Interest
Somewhat interested
Very
interested
Visiting art galleries
No
Interest
Somewhat interested
Very
interested
Visiting churchescathedrals
No
Interest
Somewhat interested
Very
interested
Visiting family
No
Interest
Somewhat interested
Very
interested
Visiting friends
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 10 of 11 Vinfen Corporation 2017
Visiting museums
No
Interest
Somewhat interested
Very
interested
Volleyball
No
Interest
Somewhat interested
Very
interested
Volunteering
No
Interest
Somewhat interested
Very
interested
Walking-beachparksforests
No
Interest
Somewhat interested
Very
interested
Writing
No
Interest
Somewhat interested
Very
interested
Yard sales
No
Interest
Somewhat interested
Very
interested
YMCA
No
Interest
Somewhat interested
Very
interested
OTHER ListDescribe
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 11 of 11 Vinfen Corporation 2017
Individual _______________________________________________________ Date _____________
Once this assessment has been completed with the individual have a discussion about which activities theyrsquove identified would be most important to focus on this ISP cycle and how they might like to access these activities For day programs identify interests that are available during day time hours The focus of these should be activities that are not currently part of the individualrsquos routine List the activities to focus on _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________
Ensure the Community Map aligns with this list
EFFECTIVE DATE 12016 REVISION DATE 4242017
Copyright copy DS Division Page 7 of 11 Vinfen Corporation 2017
Plays and Broadway shows
No
Interest
Somewhat interested
Very
interested
Poetry readings
No
Interest
Somewhat interested
Very
interested
Politics
No
Interest
Somewhat interested
Very
interested
Public gardensgreenhouses
No
Interest
Somewhat interested
Very
interested
Puzzles
No
Interest
Somewhat interested
Very
interested
Radio (visit stations)
No
Interest
Somewhat interested
Very
interested
Reading
No
Interest
Somewhat interested
Very
interested
Religious events
No
Interest
Somewhat interested
Very
interested
Restaurants (excludes fast food and drive-thru)
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 8 of 11 Vinfen Corporation 2017
Self-advocacy meetings human rights safety etc
No
Interest
Somewhat interested
Very
interested
Senior centers
No
Interest
Somewhat interested
Very
interested
Sewing
No
Interest
Somewhat interested
Very
interested
Shopping
No
Interest
Somewhat interested
Very
interested
Shows
No
Interest
Somewhat interested
Very
interested
Singing
No
Interest
Somewhat interested
Very
interested
Soccer
No
Interest
Somewhat interested
Very
interested
Social clubs
No
Interest
Somewhat interested
Very
interested
Swimming
No
Interest
Somewhat interested
Very
interested
Symphony hall
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 9 of 11 Vinfen Corporation 2017
Taking an educational class
No
Interest
Somewhat interested
Very
interested
Taking tours around Boston police stations fire stations airport sports stadiums
No
Interest
Somewhat interested
Very
interested
Television
No
Interest
Somewhat interested
Very
interested
Tennis
No
Interest
Somewhat interested
Very
interested
Traveling
No
Interest
Somewhat interested
Very
interested
Visiting art galleries
No
Interest
Somewhat interested
Very
interested
Visiting churchescathedrals
No
Interest
Somewhat interested
Very
interested
Visiting family
No
Interest
Somewhat interested
Very
interested
Visiting friends
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 10 of 11 Vinfen Corporation 2017
Visiting museums
No
Interest
Somewhat interested
Very
interested
Volleyball
No
Interest
Somewhat interested
Very
interested
Volunteering
No
Interest
Somewhat interested
Very
interested
Walking-beachparksforests
No
Interest
Somewhat interested
Very
interested
Writing
No
Interest
Somewhat interested
Very
interested
Yard sales
No
Interest
Somewhat interested
Very
interested
YMCA
No
Interest
Somewhat interested
Very
interested
OTHER ListDescribe
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 11 of 11 Vinfen Corporation 2017
Individual _______________________________________________________ Date _____________
Once this assessment has been completed with the individual have a discussion about which activities theyrsquove identified would be most important to focus on this ISP cycle and how they might like to access these activities For day programs identify interests that are available during day time hours The focus of these should be activities that are not currently part of the individualrsquos routine List the activities to focus on _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________
Ensure the Community Map aligns with this list
EFFECTIVE DATE 12016 REVISION DATE 4242017
Copyright copy DS Division Page 8 of 11 Vinfen Corporation 2017
Self-advocacy meetings human rights safety etc
No
Interest
Somewhat interested
Very
interested
Senior centers
No
Interest
Somewhat interested
Very
interested
Sewing
No
Interest
Somewhat interested
Very
interested
Shopping
No
Interest
Somewhat interested
Very
interested
Shows
No
Interest
Somewhat interested
Very
interested
Singing
No
Interest
Somewhat interested
Very
interested
Soccer
No
Interest
Somewhat interested
Very
interested
Social clubs
No
Interest
Somewhat interested
Very
interested
Swimming
No
Interest
Somewhat interested
Very
interested
Symphony hall
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 9 of 11 Vinfen Corporation 2017
Taking an educational class
No
Interest
Somewhat interested
Very
interested
Taking tours around Boston police stations fire stations airport sports stadiums
No
Interest
Somewhat interested
Very
interested
Television
No
Interest
Somewhat interested
Very
interested
Tennis
No
Interest
Somewhat interested
Very
interested
Traveling
No
Interest
Somewhat interested
Very
interested
Visiting art galleries
No
Interest
Somewhat interested
Very
interested
Visiting churchescathedrals
No
Interest
Somewhat interested
Very
interested
Visiting family
No
Interest
Somewhat interested
Very
interested
Visiting friends
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 10 of 11 Vinfen Corporation 2017
Visiting museums
No
Interest
Somewhat interested
Very
interested
Volleyball
No
Interest
Somewhat interested
Very
interested
Volunteering
No
Interest
Somewhat interested
Very
interested
Walking-beachparksforests
No
Interest
Somewhat interested
Very
interested
Writing
No
Interest
Somewhat interested
Very
interested
Yard sales
No
Interest
Somewhat interested
Very
interested
YMCA
No
Interest
Somewhat interested
Very
interested
OTHER ListDescribe
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 11 of 11 Vinfen Corporation 2017
Individual _______________________________________________________ Date _____________
Once this assessment has been completed with the individual have a discussion about which activities theyrsquove identified would be most important to focus on this ISP cycle and how they might like to access these activities For day programs identify interests that are available during day time hours The focus of these should be activities that are not currently part of the individualrsquos routine List the activities to focus on _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________
Ensure the Community Map aligns with this list
EFFECTIVE DATE 12016 REVISION DATE 4242017
Copyright copy DS Division Page 9 of 11 Vinfen Corporation 2017
Taking an educational class
No
Interest
Somewhat interested
Very
interested
Taking tours around Boston police stations fire stations airport sports stadiums
No
Interest
Somewhat interested
Very
interested
Television
No
Interest
Somewhat interested
Very
interested
Tennis
No
Interest
Somewhat interested
Very
interested
Traveling
No
Interest
Somewhat interested
Very
interested
Visiting art galleries
No
Interest
Somewhat interested
Very
interested
Visiting churchescathedrals
No
Interest
Somewhat interested
Very
interested
Visiting family
No
Interest
Somewhat interested
Very
interested
Visiting friends
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 10 of 11 Vinfen Corporation 2017
Visiting museums
No
Interest
Somewhat interested
Very
interested
Volleyball
No
Interest
Somewhat interested
Very
interested
Volunteering
No
Interest
Somewhat interested
Very
interested
Walking-beachparksforests
No
Interest
Somewhat interested
Very
interested
Writing
No
Interest
Somewhat interested
Very
interested
Yard sales
No
Interest
Somewhat interested
Very
interested
YMCA
No
Interest
Somewhat interested
Very
interested
OTHER ListDescribe
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 11 of 11 Vinfen Corporation 2017
Individual _______________________________________________________ Date _____________
Once this assessment has been completed with the individual have a discussion about which activities theyrsquove identified would be most important to focus on this ISP cycle and how they might like to access these activities For day programs identify interests that are available during day time hours The focus of these should be activities that are not currently part of the individualrsquos routine List the activities to focus on _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________
Ensure the Community Map aligns with this list
EFFECTIVE DATE 12016 REVISION DATE 4242017
Copyright copy DS Division Page 10 of 11 Vinfen Corporation 2017
Visiting museums
No
Interest
Somewhat interested
Very
interested
Volleyball
No
Interest
Somewhat interested
Very
interested
Volunteering
No
Interest
Somewhat interested
Very
interested
Walking-beachparksforests
No
Interest
Somewhat interested
Very
interested
Writing
No
Interest
Somewhat interested
Very
interested
Yard sales
No
Interest
Somewhat interested
Very
interested
YMCA
No
Interest
Somewhat interested
Very
interested
OTHER ListDescribe
No
Interest
Somewhat interested
Very
interested
Copyright copy DS Division Page 11 of 11 Vinfen Corporation 2017
Individual _______________________________________________________ Date _____________
Once this assessment has been completed with the individual have a discussion about which activities theyrsquove identified would be most important to focus on this ISP cycle and how they might like to access these activities For day programs identify interests that are available during day time hours The focus of these should be activities that are not currently part of the individualrsquos routine List the activities to focus on _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________
Ensure the Community Map aligns with this list
EFFECTIVE DATE 12016 REVISION DATE 4242017
Copyright copy DS Division Page 11 of 11 Vinfen Corporation 2017
Individual _______________________________________________________ Date _____________
Once this assessment has been completed with the individual have a discussion about which activities theyrsquove identified would be most important to focus on this ISP cycle and how they might like to access these activities For day programs identify interests that are available during day time hours The focus of these should be activities that are not currently part of the individualrsquos routine List the activities to focus on _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________
Ensure the Community Map aligns with this list
EFFECTIVE DATE 12016 REVISION DATE 4242017