Fill and Sign the General Intent Form

General Guidelines for Writing a Letter of Intent and Communicating Your Wishes to the Guardians, Trustees and the Courts about Your Child 1.The letter can be addressed TO WHOM IT MAY CONCERN or you may want to make it more personal by addressing it directly to your child. Depending on the severity of your child's disability, this letter may be a continuing form of communication after you are gone. 2.The letter can be typed or handwritten. 3.Each letter should cover the key areas of your child's life. You should describe what has happened thus far and express your desires for the future. The following topics should help you organize your thoughts: Family History 1.Where and when you were born. __________________________________________________________________ 2.Where and when you were raised. __________________________________________________________________ 3.Where and when you were married. __________________________________________________________________ 4.Something special about brothers, sisters, aunts, uncles, grandparents, and other relatives. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 5. Special friends and relatives that your child knows and likes. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________6. Description of your child's birth, when, where, your feelings, and anything else you deem relevant. __________________________________________________________________ __________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ 7.Brief overview of your child's life to date and your general feelings about the future. ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ Education Give summary of educational experiences and desires for future education. Include:1.Regular classes, special classes, special schools, and anything else you deem relevant. ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ 2.Types of educational emphasis, i.e. vocational, academic, total communication, and anything else you deem relevant. ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ 3.Name specific programs, schools, teachers, if you know them. ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ Employment 1.Types of work he or she might enjoy (e.g., open employment with supervision, sheltered workshop, activity center, and anything else you deem relevant). ____________________________________________________________________________________________________________________________________ __________________________________________________________________ 2.Companies that you are aware of that may provide employment in your community. ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ Residential Environment (in the future). 1.Live with relatives, specify relatives. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________2.If not relatives or if relatives pass away, your other options, i.e. group home in the same community, institution. __________________________________________________________________ __________________________________________________________________ 3.Specify size of group home or institution. __________________________________________________________________ 4.Describe best living arrangements (e.g. single room). ____________________________________________________________________________________________________________________________________ Social Environment 1.Mention the types of social activities your child enjoys, i.e. sports, dances, movies, and anything else you deem relevant. __________________________________________________________________ __________________________________________________________________ ____________________________________________________________________________________________________________________________________ 2.Should your child have personal spending money and how should he or she spend it? __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 3. Mention favorite foods, eating habits, and anything else you deem relevant. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________4.Does your child usually have annual vacations with relatives, friends, church or charitable groups? __________________________________________________________________ __________________________________________________________________ ____________________________________________________________________________________________________________________________________ Religious Environment 1.Specify religion, if any. __________________________________________________________________ 2. Specify local churches. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________3.Mention local ministers, priests, rabbis that are familiar with your child. ____________________________________________________________________________________________________________________________________ 4.Ask for regular visits from church members/clergy, if possible (if desired). ____________________________________________________________________________________________________________________________________ 5.Request that your child participate in church services and other activities as much as possible (if desired). __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Medical Care 1.Mention current medication being taken and the purposes of each. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________2.Discuss the drugs that have and have not worked in the past and why. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________3.Describe your feelings about the drug therapy program.__________________________________________________________________ __________________________________________________________________ __________________________________________________________________4.Discuss allergies and other medical conditions and considerations.__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Behavior Management (Support Needs) 1.Describe the current behavior management program that is being used. __________________________________________________________________ __________________________________________________________________ ____________________________________________________________________________________________________________________________________2.Mention the other behavior management programs that have been tried and give the results. __________________________________________________________________ __________________________________________________________________ ____________________________________________________________________________________________________________________________________ Final Arrangements Describe your desires for your child's final arrangements and include information about: 1.Choice of funeral home. __________________________________________________________________ 2. Cremation or burial. __________________________________________________________________ 3.Cemetery. __________________________________________________________________ 4.Monument. __________________________________________________________________ 5.Church service (memorial service). __________________________________________________________________ __________________________________________________________________Give any other information that you feel will help the future care providers in giving best possible care and supervision of your child. (For example, does your child have preferences for colors, music, sleeping late, or anything else you deem relevant? What brings your child happiness or pleasure?). ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________ ________________________________________________________________________