Lakeshore Technical College Child Care Services/Early Childhood Education Program
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Lakeshore Technical College Child Care Services/Early Childhood Education Program Functional Abilities Statement of Understanding The Americans with Disabilities Act of 1990, the Americans with Disabilities Amendments Act of 2008, and Section 504 of the Rehabilitation act of 1973 (29 U.S.C. sec. 794) prohibits discrimination of persons because of her or his disability. In keeping with these laws, colleges of the Wisconsin Technical College System make every effort to insure a quality education for students. The purpose of this document is to ensure that students acknowledge that they have been provided information on the functional abilities required of a student in the Childcare Services/ Early Childhood Education Program. If you have a documented disability that may prevent you from meeting the functional abilities as stated, you are encouraged to contact LTC’s Disability Services Coordinator for assistance with accommodations. It is your responsibility to voluntarily and confidentially disclose information regarding the nature and extent of a disability and to provide documentation of the disability. The college cannot assume responsibility for providing accommodations or services to students who have not identified themselves as having a qualifying disability. Please note that program requirements will not be waived, but accommodations may be made to assist you to meet requirements. Please contact Patrick Neuenfeldt, Disability Services Coordinator, at 920.693.1222, or email patrick.neuenfeldt@gotoltc.edu for assistance in formulating a reasonable accommodation plan. This form is to be completed upon admission to the program ______ I have read and I understand the Functional Ability Categories specific to a student in the Child Care Services or (initials) Early Childhood Education Program. ______ I am able to meet the Functional Abilities as presented, and have been provided with information concerning (initials) accommodations or special services if needed at this time. Name of Student____________________________________________________________________________________ Signature of Student_________________________________________________ Student Identification Number or Date of Birth___________________________ Return completed form to: Admissions Lakeshore Technical College 1290 North Avenue Cleveland, WI 53015-1414 Date_______________________ Lakeshore Technical College Functional Ability Categories & Representative Activities for the Child Care Services/Early Childhood Program In order to be successful in the field of Early Childhood, the following skills and abilities are needed BEFORE you begin the program. For each item, check yes or no. If you can only do the particular skill with adaptation, please give more information. For example, if you can only push and pull objects up to 40 pounds with a particular adaptation, describe the adaptation. Use additional space as needed. Gross Motor Skills CAN YOU…. Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Push and pull objects up to 40 lbs on a frequent basis (e.g. strollers, wagons)? Lift and carry objects up to 40 lbs without losing stability or balance? Bend, stoop, kneel, squat (or otherwise get to child level) quickly without losing stability or balance? Reach above own shoulders to access or replace equipment and supplies? Arrange environment (furniture and supplies) to prepare for activities, ensuring safety and accessibility? Transport/evacuate children in emergencies? Hold children’s hands as you guide them to and from different areas? Move within confined spaces? Reach below waist (e.g. to plug in appliances, pick up toys)? Reach in front of own body (e.g. to hold children, show books and toys, help diaper/dress children, set tables, etc.)? Physically participate in children’s group games? Please describe adaptations/accommodations needed to perform any of the skills checked above: Physical Endurance CAN YOU…. Yes____No____With Adaptation____ Yes____No____With Adaptation____ Tolerate long periods of sitting, standing, and/or walking/mobility without becoming fatigued? Sustain repetitive movements (e.g. playing, pushing swings, etc.)? Please describe adaptations/accommodations needed to perform any of the skills checked above: Fine Motor Skills CAN YOU…. Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Perform moderate manipulative tasks such as writing, fastening buttons/zippers, turning pages in a book, etc.? Pick up objects with hands? Manipulate a book in a way to shows small groups of children the pictures? Write with a pen or pencil? Key/type (use a computer) Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Twist objects (e.g. turn door knobs, open bottle tops, open lunch containers, etc.)? Squeeze (e.g. open medications, handle small items)? Make games and learning materials for children? Write notes for record keeping and maintaining written progress notes? Provide hands-on assistance with self care activities such as dressing and feeding? Change diapers and help with toileting needs? Please describe adaptations/accommodations needed to perform any of the skills checked above: Reading & Writing CAN YOU…. Yes____No____With Adaptation____ Yes____No____With Adaptation____ Read, write and understand written documents such as books, parent notes, calendars, activity plans, medication instructions, progress notes, emergency procedures, etc.? Read aloud in front of audiences of children and adults? Please describe adaptations/accommodations needed to perform any of the skills checked above: Math CAN YOU…. Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Tell time? Add and subtract basic numbers? Document numbers in records (charts, medication dispersal, etc.)? Measure quantities for snack or food preparation? Dial phone numbers to summon emergency assistance? Please describe adaptations/accommodations needed to perform any of the skills checked above: Hearing CAN YOU…. Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Distinguish normal sounds from background noises? Hear normal speaking level sounds? Hear faint voices and/or body sounds (e.g. that may indicate child’s pain, needs, etc.)? Hear fire alarms, apnea monitors, telephones & doorbells ringing? Differentiate playful from harmful play sounds in a loud setting? Please describe adaptations/accommodations needed to perform any of the skills checked above: Vision CAN YOU…. Yes____No____With Adaptation____ Identify children/adolescents, co-workers, and visitors from a Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ distance of 10 feet? Read typed and written correspondence (books, parent notes, calendars, activity plans, etc.)? See objects 20 inches away (e.g. computer screens, skin conditions)? Use peripheral vision and depth perception (e.g. to help children safely cross streets, climb stairs, etc.)? Distinguish color and color intensity (e.g. to determine if a child looks pale, has a rash, matches colored objects correctly)? Determine safety standards of equipment (e.g. loose nuts & bolts, frayed cords, dangerous areas, uneven surfaces, etc.)? Please describe adaptations/accommodations needed to perform any of the skills checked above: Environment CAN YOU…. Yes____No____With Adaptation____ TOLERATE THE FOLLOWING: Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Supervise children’s play activities, enforcing safety rules? Exposure to bodily fluids (diaper changes, bloody or runny noses, etc.)? Bacteria and infectious agents from ill children? Exposure to chemicals and agents such as disinfectants, soaps, cleaners, bleaches, etc.? Minor bodily injuries (scrapes, bruises, bites) caused by the unpredictable behaviors of young children? Exposure to loud and/or unpleasant noises due to the unpredictable nature of young children? Exposure to strong odors (e.g. cleaning supplies, dirtied diapers)? Please describe adaptations/accommodations needed to perform any of the skills checked above: Emotional Stability CAN YOU…. Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Provide children and families with emotional support? Respond to a crisis situation in a manner that maintains the health and safety of the children in the classroom/program? Cope with own emotions? Cope with strong emotions in others (anger, fear, grief)? Concentrate on details despite frequent interruption? Respect/value diversity in others, individual differences, values and beliefs? Exhibit honesty including but not limited to all social interactions, assignments, assessments and academics? Adapt to changing conditions, environments/stress? Plan for the unexpected, including making eating or transportation arrangements before class? Refrain from intimidating others by making sounds, noises, or physical gestures in reaction to others or in reaction to unexpected events. For Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ example, students interacting with each other, equipment malfunctions, earning lower grades/scores than expected on a project, etc.? Attend class, lab, or practicum in accordance with LTC student code of conduct? Ask for help or guidance in a manner appropriate for a classroom/lab/practicum environment? Be awake, alert and attentive in class for your learning process and safety around equipment and children? Follow common safety rules and directions for smoking, handling materials or equipment in a way that does not injure self or others, including wearing program appropriate attire? Prepare adequately for class, internship, and/or practicum site? Complete assignments as assigned and take tests in a reasonable time frame? Behave appropriately around and toward other students, faculty, staff, children and parents/family members of children? Listen to and acknowledge feedback? Accept constructive feedback? Correct errors when coached? Focus attention on professional tasks? Please describe adaptations/accommodations needed to perform any of the skills checked above: Analytical Thinking CAN YOU…. Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Perform multiple responsibilities concurrently? Process and interpret information from multiple sources? Problem solve effectively? Evaluate outcomes? Prioritize tasks? Use long-term memory? Use short-term memory? Please describe adaptations/accommodations needed to perform any of the skills checked above: Critical Thinking CAN YOU…. Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Identify cause and effect relationships? Plan and implement activities for others? Provide identifiable activity routines for children and facilitate transitions? Sequence information? Make decisions independently? Adapt decisions based on new information? Modify environments based on individual needs of children? Please describe adaptations/accommodations needed to perform any of the skills checked above: Interpersonal Skills CAN YOU…. Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Establish and maintain professional relationships? Establish rapport with families and community groups? Negotiate/mediate interpersonal conflict? Respect dignity and rights of all children and adults? Encourage and model positive social relationships and habits? Model mature and respectful behavior at all times in the presence of children as well as in all classroom and professional settings? Present information before large and small groups of children and adults? Show respect for diversity in culture, religion, sexual orientation, marital status, socio-economic status, and abilities/disabilities? Interact as part of a class or internship work group/team? Actively participate in group work, discussions, and activities? Demonstrate respect for others’ points of view and a willingness to be receptive to differing opinions? Refrain from talking in a way that could be considered abusive or rude? Accept constructive feedback and accept responsibility for own actions? Behave appropriately (in accordance with LTC student code of conduct) around and towards others in the campus community? Communicate without the use of aggressive statements, demeaning statements, or suggestions of physical violence? Refrain from taking indecent liberties that could be construed as sexual harassment/discrimination toward others in the campus community? Please describe adaptations/accommodations needed to perform any of the skills checked above: Communication Skills CAN YOU…. Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Speak loudly enough to be heard in a noisy room? Speak at an understandable, conversational level? interact with parents and co-workers in a positive, friendly manner? Speak and write English so that children, parents and co-workers can understand? Communicate information and ideas so others will understand? Present learning activities in front of large and small groups of children and adults? Follow directions from others? Listen and comprehend the written/spoken word? Collaborate with others (e.g. therapists, health care workers, etc.)? Recognize and respect family/child confidentiality? Yes____No____With Adaptation____ Yes____No____With Adaptation____ Yes____No____With Adaptation____ Participate in staff meetings, training sessions and meet continuing education requirements as outlined in state certification/licensing regulations? work cooperatively with staff to develop the potential of individual children? interact with others and report observations? Please describe adaptations/accommodations needed to perform any of the skills checked above:
