* 1. WSC Name as it appears in iBudget (ONE name per response):

* 2. WSC Agency (If Applicable):

* 3. WSC Email address:

* 4. WSC Medicaid Provider ID (treating provider):

* 5. Which of these statements are characteristics of person-centered planning?

* 6. Which of the following is a true statement regarding developing Person-Centered Goals?

* 7. Which of the following are examples of goals that are written from a Person-Centered approach?

* 8. Arnold is 24 years old and lives in his family home. Arnold has been working at the local grocery store for two years and says that he likes working there, though his father mentioned that his attendance has been inconsistent the past three months. Arnold said that he “wants more friends” and “really enjoys being outside.” Which of the following are ways to engage with Arnold to make sure that his employment goal is addressing what he desires for his future?

* 9. 1.       Mary and her team of supports are meeting to plan for her support plan goals for the next year. Mary is non-verbal and requires a high level of assistance in all areas of her life. Therefore, her legal guardian, Mike, is communicating on her behalf. Mike states that the most important thing for Mary is to remain happy and safe for this year. Which of the following are ways to engage in a conversation with both Mary and Mike to help define what “happy and safe” is for Mary?

* 10. True or False, Waiver Support Coordinators are responsible to develop Person-Centered goals that include not just Waiver services, but also unpaid supports such as community resources?

* 11. When must WSCs review and update the individual’s and legal guardian contact information?

* 12. All persons have the right to live their life in a way that is chosen by them and respected by those around them. Examples of rights to address in the support plan include:

* 13. For someone living in a licensed group home or in their own home, which of the following is important to ask them at least annually?

* 14. True or False, a back-up plan is needed for every need/goal listed on the support plan?

* 15. By checking this box and identifying a date below, I certify that I viewed all 4 modules of Person-Centered Planning presented by the Agency for Persons with Disabilities. I understand that I must retain a copy of the confirmation received for my records as documentation that the training was completed. Falsification of this information is considered fraudulent and could result in the termination of my Medicaid Waiver Services Agreement.

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