Getting Started

***Note: Please complete the entire survey in one session; partial responses cannot be retrieved later to finish the assessment in multiple sessions. The assessment will take approximately 45-60 minutes to complete.
  1. Schedule a time when you and your worker or other supportive adult can take the assessment together.
  2. Complete the assessment with your worker or other supportive adult.
  3. For each question, think about how the question describes you now or within the past 3 months, and select the answer that best fits you for this time period.
  4. If you have comments or ideas regarding a question, or you want to include something on your plan, add the comment in the box below the question.
  5. Your results report will be emailed to you the same day your assessment is submitted. The results report will be emailed to you, your worker, and your placement provider, as long as email addresses are provided in the assessment. If you do not receive your results report, please e-mail us at If you do not include an email address for yourself in the assessment, ask your worker for a copy of the results report.
  6. Discuss the results report with your worker and other supportive adults, and create a  Plan for My Future or a tribal plan using the report.

* 1. What is today's date?


* 2. What is your client ID Number? If you're not sure, please speak with your worker. If you do not have a client ID number, please enter 1234567.

* 3. What is your email address?
(Not required. If you would like a copy of your assessment results report, include your email here. Otherwise, please ask your worker for a copy.)

* 4. What is your date of birth?


* 5. What is your first name? (Full first name only)

* 6. What is the first letter of your last name? (First letter only)

* 7. Which of the following best represents you?

* 8. What is your worker's name?

* 9. What is your worker's email address?
(Required. A copy of your assessment results will be sent to your worker, to assist you with your Plan for My Future.)

* 10. What is your placement provider's e-mail address (foster parent, group home staff, etc.)?
(Not Required. If you would like a copy of your assessment results report to be sent to your placement provider, include his or her email here.)